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.
■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。