Aims Prediction of mitral (MR) and tricuspid (TR) regurgitation progression on transthoracic echocardiography (TTE) is needed to personalize valvular surveillance intervals and prognostication. Methods and results Structured TTE report data at Beth Israel Deaconess Medical Center, 26 January 2000–31 December 2017, were used to determine time to progression (≥1+ increase in severity). TTE predictors of progression were used to create a progression score, externally validated at Massachusetts General Hospital, 1 January 2002–31 December 2019. In the derivation sample (MR, N = 34 933; TR, N = 27 526), only 5379 (15.4%) individuals with MR and 3630 (13.2%) with TR had progression during a median interquartile range) 9.0 (4.1–13.4) years of follow-up. Despite wide inter-individual variability in progression rates, a score based solely on demographics and TTE variables identified individuals with a five- to six-fold higher rate of MR/TR progression over 10 years (high- vs. low-score tertile, rate of progression; MR 20.1% vs. 3.3%; TR 21.2% vs. 4.4%). Compared to those in the lowest score tertile, those in the highest tertile of progression had a four-fold increased risk of mortality. On external validation, the score demonstrated similar performance to other algorithms commonly in use. Conclusion Four-fifths of individuals had no progression of MR or TR over two decades. Despite wide interindividual variability in progression rates, a score, based solely on TTE parameters, identified individuals with a five- to six-fold higher rate of MR/TR progression. Compared to the lowest tertile, individuals in the highest score tertile had a four-fold increased risk of mortality. Prediction of long-term MR/TR progression is not only feasible but prognostically important.

中文翻译：

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预测长期二尖瓣和三尖瓣反流进展的超声心动图算法的开发和验证

需要经胸超声心动图 (TTE) 预测二尖瓣 (MR) 和三尖瓣 (TR) 反流进展，以个性化瓣膜监测间隔和预后。方法和结果 贝斯以色列女执事医疗中心的结构化 TTE 报告数据，2000 年 1 月 26 日至 2017 年 12 月 31 日，用于确定进展时间（严重程度增加≥1+）。2002 年 1 月 1 日至 2019 年 12 月 31 日，TTE 进展预测因子用于创建进展评分，并在麻省总医院进行了外部验证。在推导样本（MR，N = 34 933；TR，N = 27 526）中，只有 5379（ 15.4% 的 MR 患者和 3630 名 (13.2%) 的 TR 患者在四分位数中位数范围内进展）9.0 (4.1–13.4) 年的随访。尽管进展率存在很大的个体差异，仅基于人口统计学和 TTE 变量的评分确定了 10 年内 MR/TR 进展率高出五到六倍的个体（高分与低分三分位数，进展率；MR 20.1% 对 3.3% ；TR 21.2% 对 4.4%）。与得分最低的三分位数相比，进展最高三分位数的那些人的死亡率增加了四倍。在外部验证中，该分数表现出与其他常用算法相似的性能。结论 在二十年内，五分之四的人没有出现 MR 或 TR 进展。尽管进展率存在很大的个体差异，但仅基于 TTE 参数的评分确定了 MR/TR 进展率高出五到六倍的个体。与最低的三分位数相比，得分最高的人死亡风险增加四倍。预测长期 MR/TR 进展不仅可行，而且对预后也很重要。