PDF(Pubmed)
Abstract：
UNASSIGNED: The prognostic value of functional tricuspid valve regurgitation (TR) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study primarily aims to quantify the prognostic role of TR in relation to right ventricle (RV) dysfunction on clinical outcomes and secondarily the evolution of TR and RV dysfunction over time.
UNASSIGNED: Adult PAH or CTEPH patients diagnosed by right heart catheterization were included. Exclusion criteria were prevalent patients and age < 18 years.The primary endpoint was a composite of death or lung transplantation. Longitudinal evolution of TR and RV dysfunction were modelled with generalized mixed-effect models, which were inserted in a cox model under the joint-modelling framework in order to investigate the association of TR and RV dysfunction with the endpoint.
UNASSIGNED: We included 76 PAH and 44 CTEPH patients (median age:59, females:62 %), with a mean follow-up of 3.2 ± 2.1 years. 31 patients reached the endpoint (2 transplant, 29 mortality). On average the probability of moderate-to-severe TR decreased during follow-up, whereas the probability of moderate-to-severe RV dysfunction remained stable. The cumulative effect of moderate-to-severe TR (HRper day 1.01 95 %CI[1.00-1.01],P < 0.001) and moderate-to-severe RV dysfunction (HRper day: 1.01 95 %CI[1.00-1.01],P < 0.001) was associated with the endpoint in univariable joint-models. In a multivariable joint-model with both the evolutions of TR and RV dysfunction only TR remained significant (HR per day: 1.01 95 %CI[1.00-1.01],P < 0.001).
UNASSIGNED: Persistent moderate-to-severe tricuspid valve regurgitation during follow-up predicts adverse outcomes and might be a better predictor of lung transplantation and mortality compared to right ventricle dysfunction.
UNASSIGNED: Adult PAH or CTEPH patients diagnosed by right heart catheterization were included. Exclusion criteria were prevalent patients and age < 18 years.The primary endpoint was a composite of death or lung transplantation. Longitudinal evolution of TR and RV dysfunction were modelled with generalized mixed-effect models, which were inserted in a cox model under the joint-modelling framework in order to investigate the association of TR and RV dysfunction with the endpoint.
UNASSIGNED: We included 76 PAH and 44 CTEPH patients (median age:59, females:62 %), with a mean follow-up of 3.2 ± 2.1 years. 31 patients reached the endpoint (2 transplant, 29 mortality). On average the probability of moderate-to-severe TR decreased during follow-up, whereas the probability of moderate-to-severe RV dysfunction remained stable. The cumulative effect of moderate-to-severe TR (HRper day 1.01 95 %CI[1.00-1.01],P < 0.001) and moderate-to-severe RV dysfunction (HRper day: 1.01 95 %CI[1.00-1.01],P < 0.001) was associated with the endpoint in univariable joint-models. In a multivariable joint-model with both the evolutions of TR and RV dysfunction only TR remained significant (HR per day: 1.01 95 %CI[1.00-1.01],P < 0.001).
UNASSIGNED: Persistent moderate-to-severe tricuspid valve regurgitation during follow-up predicts adverse outcomes and might be a better predictor of lung transplantation and mortality compared to right ventricle dysfunction.
摘要：
■功能性三尖瓣反流（TR）在肺动脉高压和慢性血栓栓塞性肺动脉高压（CTEPH）患者中的预后价值尚不确定。这项研究主要旨在量化TR与右心室（RV）功能障碍对临床结果的预后作用，其次是TR和RV功能障碍随时间的演变。
■纳入由右心导管插入术诊断的成人PAH或CTEPH患者。排除标准为患者普遍且年龄<18岁。主要终点是死亡或肺移植的复合终点。用广义混合效应模型对TR和RV功能障碍的纵向演变进行建模，将其插入联合建模框架下的cox模型中，以研究TR和RV功能障碍与终点的关联。
■我们纳入了76例PAH和44例CTEPH患者（中位年龄：59岁，女性：62％），平均随访3.2±2.1年。31例患者达到终点（2例移植，29死亡率）。平均而言，在随访期间中度至重度TR的概率降低，而中度至重度RV功能障碍的概率保持稳定.中度至重度TR的累积效应（HRperday1.0195CI[1.00-1.01]，P<0.001）和中度至重度RV功能障碍（每天心率：1.0195CI[1.00-1.01]，P<0.001)与单变量关节模型的终点相关。在具有TR和RV功能障碍演变的多变量联合模型中，只有TR仍然显着（每天HR：1.0195CI[1.00-1.01]，P<0.001)。
■与右心室功能障碍相比，随访期间持续的中度至重度三尖瓣反流可预测不良结局，并且可能是肺移植和死亡率的更好预测指标。
■纳入由右心导管插入术诊断的成人PAH或CTEPH患者。排除标准为患者普遍且年龄<18岁。主要终点是死亡或肺移植的复合终点。用广义混合效应模型对TR和RV功能障碍的纵向演变进行建模，将其插入联合建模框架下的cox模型中，以研究TR和RV功能障碍与终点的关联。
■我们纳入了76例PAH和44例CTEPH患者（中位年龄：59岁，女性：62％），平均随访3.2±2.1年。31例患者达到终点（2例移植，29死亡率）。平均而言，在随访期间中度至重度TR的概率降低，而中度至重度RV功能障碍的概率保持稳定.中度至重度TR的累积效应（HRperday1.0195CI[1.00-1.01]，P<0.001）和中度至重度RV功能障碍（每天心率：1.0195CI[1.00-1.01]，P<0.001)与单变量关节模型的终点相关。在具有TR和RV功能障碍演变的多变量联合模型中，只有TR仍然显着（每天HR：1.0195CI[1.00-1.01]，P<0.001)。
■与右心室功能障碍相比，随访期间持续的中度至重度三尖瓣反流可预测不良结局，并且可能是肺移植和死亡率的更好预测指标。
