{"title":"急性心肌梗死患者三尖瓣反流的临床影响。","authors":"Shun Nishino, Chiharu Nishino, Michikazu Nakai, Kensaku Nishihira, Nehiro Kuriyama, Yoshisato Shibata","doi":"10.1002/ehf2.15375","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>The clinical impact of tricuspid regurgitation (TR) in patients after acute myocardial infarction (AMI) is largely unknown. The aim of this study was to clarify the prevalence and prognostic impact of TR in post-AMI patients treated with appropriate primary percutaneous coronary intervention (PCI).</p>\n </section>\n \n <section>\n \n <h3> Methods and results</h3>\n \n <p>Three hundred fifty-one consecutive patients with first-onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two- and three-dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (−) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re-hospitalization for congestive heart failure and recurrent MI. Seventy-eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6-year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 [95% confidence interval, 1.48–4.44]; <i>P</i> < 0.001). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (<i>P</i> = 0.026). Multivariable analysis identified the left anterior descending coronary artery as the culprit vessel, left atrial dilation (>34 mL/m<sup>2</sup>), reduced left ventricular ejection fraction (<50%) and the presence of significant (≥mild) ischaemic mitral regurgitation as independent predictors of mild or greater residual TR after primary PCI for AMI at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, [95% confidence interval, 1.01–3.48]; <i>P</i> = 0.048).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first-onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3461-3474"},"PeriodicalIF":3.7000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15375","citationCount":"0","resultStr":"{\"title\":\"Clinical impact of tricuspid regurgitation in patients with acute myocardial infarction\",\"authors\":\"Shun Nishino, Chiharu Nishino, Michikazu Nakai, Kensaku Nishihira, Nehiro Kuriyama, Yoshisato Shibata\",\"doi\":\"10.1002/ehf2.15375\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>The clinical impact of tricuspid regurgitation (TR) in patients after acute myocardial infarction (AMI) is largely unknown. The aim of this study was to clarify the prevalence and prognostic impact of TR in post-AMI patients treated with appropriate primary percutaneous coronary intervention (PCI).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods and results</h3>\\n \\n <p>Three hundred fifty-one consecutive patients with first-onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two- and three-dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (−) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re-hospitalization for congestive heart failure and recurrent MI. Seventy-eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6-year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 [95% confidence interval, 1.48–4.44]; <i>P</i> < 0.001). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (<i>P</i> = 0.026). Multivariable analysis identified the left anterior descending coronary artery as the culprit vessel, left atrial dilation (>34 mL/m<sup>2</sup>), reduced left ventricular ejection fraction (<50%) and the presence of significant (≥mild) ischaemic mitral regurgitation as independent predictors of mild or greater residual TR after primary PCI for AMI at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, [95% confidence interval, 1.01–3.48]; <i>P</i> = 0.048).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>The presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first-onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.</p>\\n </section>\\n </div>\",\"PeriodicalId\":11864,\"journal\":{\"name\":\"ESC Heart Failure\",\"volume\":\"12 5\",\"pages\":\"3461-3474\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2025-07-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15375\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ESC Heart Failure\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15375\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ESC Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15375","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Clinical impact of tricuspid regurgitation in patients with acute myocardial infarction
Aims
The clinical impact of tricuspid regurgitation (TR) in patients after acute myocardial infarction (AMI) is largely unknown. The aim of this study was to clarify the prevalence and prognostic impact of TR in post-AMI patients treated with appropriate primary percutaneous coronary intervention (PCI).
Methods and results
Three hundred fifty-one consecutive patients with first-onset AMI who underwent successful primary PCI from July 2014 to December 2018 were retrospectively examined. Standard two- and three-dimensional echocardiography were performed at discharge. Based on the presence or absence of mild or greater TR, patients were divided into TR (+) and TR (−) groups, respectively. The primary outcome was the incidence of major adverse cardiac events (MACE), defined as the composite of death, re-hospitalization for congestive heart failure and recurrent MI. Seventy-eight (22.2%) patients had mild or greater TR. Kaplan–Meier analysis showed that the cumulative 6-year incidence of MACE was significantly higher in the TR (+) group (hazard ratio, 2.56 [95% confidence interval, 1.48–4.44]; P < 0.001). In the analysis of the severity of TR, the prognosis of patients with mild TR was significantly worse than that of patients without TR (P = 0.026). Multivariable analysis identified the left anterior descending coronary artery as the culprit vessel, left atrial dilation (>34 mL/m2), reduced left ventricular ejection fraction (<50%) and the presence of significant (≥mild) ischaemic mitral regurgitation as independent predictors of mild or greater residual TR after primary PCI for AMI at discharge. Following adjustment for significant clinical parameters, mild or greater TR at discharge was still associated with a significant hazard ratio for the occurrence of MACE (1.87, [95% confidence interval, 1.01–3.48]; P = 0.048).
Conclusions
The presence of mild or greater TR at discharge may serve as a poor prognostic marker in patients with first-onset AMI. In addition to traditional clinical risk factors, it is important to pay more attention to TR and to manage it appropriately.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.