经导管三尖瓣干预与最佳药物治疗单独治疗严重三尖瓣反流：重建事件时间数据的最新荟萃分析

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-09-13 DOI:10.1016/j.ijcha.2025.101794

Ahmed Ibrahim , Laila Shalabi , Sofian Zreigh , Shrouk Ramadan , Ahmed Samir , Mohamed Adel Elsawy , Mohamed Mahmoud Fathy , Belal Mohamed Hamed , Hossam Elbenawi , Mustafa Turkmani , Ahmed Y. Azzam , Hani Mahmoud-Elsayed , Islam Y. Elgendy

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引用次数: 0

摘要

背景：严重三尖瓣反流（TR）与高死亡率和发病率密切相关。本荟萃分析旨在比较经导管三尖瓣介入治疗（TTVI）与单纯最佳药物治疗（OMT）在严重tr患者中的疗效。方法系统检索电子数据库，以确定比较TTVI与OMT的随机对照试验（rct）和倾向评分匹配的观察性研究。主要结局为全因死亡率。使用随机效应模型计算总估计值。结果共纳入5项研究（3项随机对照试验，2项观察性研究，n = 1988例）。TTVI与全因死亡率降低的无显著趋势相关（风险比[RR]: 0.70, 95%可信区间[CI] 0.48-1.03; P = 0.071），主要由观察性研究驱动。TTVI在TR严重程度降低（RR: 7.82, 95% CI 5.60-10.93; P < 0.0001）、堪萨斯城心肌病问卷测量的健康状况改善（平均差异：+14.46点，95% CI 11.55-17.38; P < 0.0001）和降低心力衰竭（HF）住院率方面显示出显著的益处（RR: 0.73, 95% CI 0.56-0.96; P = 0.025）。然而，TTVI与大出血风险增加相关（RR: 3.21, 95% CI 1.61-6.39; P = 0.0009）。结论在严重TR患者中，TTVI与全因死亡率的降低无统计学相关性，但与HF住院风险降低、TR严重程度显著降低和生活质量改善相关。未来需要大规模的随机对照试验来证实这些发现，并确定受益最大的患者亚群。系统评价方案：CRD420251002402 （PROSPERO）

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Transcatheter tricuspid valve intervention versus optimal medical therapy alone for severe tricuspid regurgitation: an updated meta-analysis with reconstructed time-to-event data

Background

Severe tricuspid regurgitation (TR) is strongly associated with high mortality and morbidity. This meta-analysis aims to compare the outcomes of transcatheter tricuspid valve intervention (TTVI) versus optimal medical treatment (OMT) alone among patients with severe TR.

Methods

Electronic databases were systematically searched to identify randomized controlled trials (RCTs) and propensity score-matched observational studies comparing TTVI with OMT. The primary outcome was all-cause mortality. Summary estimates were calculated using a random-effects model.

Results

Five studies (3 RCTs, 2 observational; n = 1988 patients) were included. TTVI was associated with a nonsignificant trend toward a lower incidence of all-cause mortality (risk ratio [RR]: 0.70, 95 % confidence interval [CI] 0.48–1.03; P = 0.071), primarily driven by observational studies. TTVI demonstrated significant benefits in terms of TR severity reduction (RR: 7.82, 95 % CI 5.60–10.93; P < 0.0001), enhanced health status as measured by the Kansas City Cardiomyopathy Questionnaire (mean difference: +14.46 points, 95 % CI 11.55–17.38; p < 0.0001), and reduced heart failure (HF) hospitalization rates (RR: 0.73, 95 % CI 0.56–0.96; P = 0.025). However, TTVI was associated with an increased risk of major bleeding (RR: 3.21, 95 % CI 1.61–6.39; P = 0.0009).

Conclusion

Among patients with severe TR, TTVI was not statistically associated with a lower incidence of all-cause mortality but was associated with a reduced risk of HF hospitalization, significant reduction in TR severity, and improved quality of life. Future large RCTs with extended follow-up are needed to confirm these findings and identify the subset of patients who benefit the most.

Systematic review protocol: CRD420251002402 (PROSPERO)

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.