Background

The outcome of tricuspid regurgitation (TR) remains unclear because of heterogeneity of etiology and the contradictory results of outcome studies. The aim of this study was to evaluate the clinical outcomes of TR in patients with pulmonary hypertension (PH) and normal left systolic function, stratified to patients with post- or precapillary PH.

Methods

In patients with no left valvar disease (isolated) functional TR, preserved left systolic function (ejection fraction ≥ 50%), and PH (systolic pulmonary pressure > 50 mm Hg), TR was assessed both qualitatively (grade) and semiquantitatively using the vena contracta method, and retrospective analysis of long-term outcomes was conducted. Patients with severe comorbid diseases were excluded.

Results

The study included 245 patients (age 80.5 years, 37% men, ejection fraction 57%, all with pulmonary systolic pressure > 50 mm Hg). At least moderate to severe TR was diagnosed in 178 patients, and their outcomes were compared with those of 67 patients with the same characteristics and less than mild TR. At least moderate to severe TR was associated with lower survival, independent of all characteristics, right ventricular size or function, comorbidity, or pulmonary pressure (P = .03 for grade and P = .02 for vena contracta). Cox proportional-hazard analysis with interaction terms for TR severity and etiology of PH (post- vs precapillary) showed that the etiology of PH did not affect the association of TR with outcome (P = .90 for the interaction term).

Conclusions

At least moderate to severe isolated TR is independently associated with excess mortality in patients with preserved systolic function and PH, warranting heightened attention to diagnosis and grading. This is irrespective of etiology (pre- or postcapillary) of PH. Semiquantitative assessment of TR by vena contracta is an independent associate of outcome, superior to standard qualitative assessment.

中文翻译：

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保留左心室射血分数和肺动脉高压的孤立性三尖瓣关闭不全的临床结果

背景

由于病因学的异质性和结局研究的矛盾结果，三尖瓣关闭不全（TR）的结果尚不清楚。这项研究的目的是评估肺动脉高压（PH）和左收缩期功能正常的TR患者的临床结局，并与毛细血管扩张后或毛细血管扩张前患者进行分层。

方法

在无左瓣膜疾病（孤立）功能性TR，保留左收缩功能（射血分数≥50％）和PH（收缩性肺压> 50 mm Hg）的患者中，使用腔静脉对TR进行定性（半定量）和半定量评估合同法，并进行长期结果的回顾性分析。患有严重合并症的患者被排除在外。

结果

该研究纳入了245例患者（年龄80.5岁，男性37％，射血分数57％，所有患者的肺收缩压均> 50 mm Hg）。178例患者至少诊断为中度至重度TR，并将其结果与67例特征相同且轻度TR较轻的患者进行比较。至少中度至重度TR与较低的生存率相关，而不受所有特征，右心室大小或功能，合并症或肺压的影响（ 分级为P = .03  ，腔静脉收缩为P = .02）。Cox比例风险分析与TR严重程度和PH的病因（毛细血管后或毛细血管前）的交互作用项表明，PH的病因学不会影响TR与预后的关联（ 交互作用项P = 0.90）。

结论

至少具有中度至重度孤立性TR的患者，其收缩功能和PH值保持不变时，其死亡率会过高，因此应更加重视诊断和分级。这与PH的病因（毛细血管前或毛细血管扩张）无关。腔静脉收缩术对TR的半定量评估是结果的独立关联，优于标准的定性评估。