Abstract：
BACKGROUND: Functional tricuspid regurgitation (TR) can develop either because of right ventricular (RV) remodeling (ventricular functional TR) and/or right atrial dilation (atrial functional TR).
OBJECTIVE: This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+).
METHODS: MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements.
RESULTS: Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, -6.3% [95% CI: -11.1% to -1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, -4.4% [95% CI: -5.9% to -2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, -4.1% [95% CI: -7.6% to -0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, -1.9% [95% CI: -2.5% to -1.3%]; P < 0.001) and mortality.
CONCLUSIONS: RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).
OBJECTIVE: This meta-analysis aimed to investigate the association between right heart remodeling and long-term (>1 year) all-cause mortality in patients with significant TR (at least moderate, ≥2+).
METHODS: MEDLINE, ISI Web of Science, and SCOPUS databases were searched. Studies reporting data on at least 1 RV functional parameter and long-term all-cause mortality in patients with significant TR were included. This study was designed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) requirements.
RESULTS: Out of 8,902 studies, a total of 14 were included, enrolling 4,394 subjects. The duration of follow-up across the studies varied, ranging from a minimum of 15.5 months to a maximum of 73.2 months. Overall, long-term all-cause mortality was 31% (95% CI: 20%-41%; P ≤ 0.001). By means of meta-regression analyses, an inverse relation was found between tricuspid annular plane systolic excursion (11 studies enrolling 3,551 subjects, -6.3% [95% CI: -11.1% to -1.4%]; P = 0.011), RV fractional area change (9 studies, 2,975 subjects, -4.4% [95% CI: -5.9% to -2.9%]; P < 0.001), tricuspid annular dimension (7 studies, 2,986 subjects, -4.1% [95% CI: -7.6% to -0.5%]; P = 0.026), right atrial area (6 studies, 1,920 subjects, -1.9% [95% CI: -2.5% to -1.3%]; P < 0.001) and mortality.
CONCLUSIONS: RV dysfunction parameters are associated to worse clinical outcomes in patients with TR, whereas right atrial dilatation is linked to a better prognostic outcome. Further studies are needed to unravel the pathophysiological differences within the functional TR spectrum. (Right heart remodeling and outcomes in patients with tricuspid regurgitation; CRD42023418667).
摘要：
背景：功能性三尖瓣反流（TR）可由于右心室（RV）重塑（心室功能性TR）和/或右心房扩张（心房功能性TR）而发生。
目的：本荟萃分析旨在探讨右心重塑与显著TR患者长期（>1年）全因死亡率之间的关系（至少中度，≥2+)。
方法：MEDLINE，ISIWebofScience,和SCOPUS数据库进行了搜索。研究报告了至少1项RV功能参数和显著TR患者长期全因死亡率的数据。本研究是根据PRISMA（系统审查和荟萃分析的首选报告项目）要求设计的。
结果：在8,902项研究中，总共包括14个，招收4394个科目。所有研究的随访时间各不相同，从最少15.5个月到最多73.2个月不等。总的来说,长期全因死亡率为31%(95%CI:20%-41%;P≤0.001).通过荟萃回归分析，发现三尖瓣环平面收缩期偏移之间存在负相关关系(11项研究纳入3551名受试者，-6.3%[95%CI：-11.1%至-1.4%]；P=0.011)，RV分数面积变化(9项研究，2,975名受试者，-4.4%[95%CI：-5.9%至-2.9%]；P<0.001)，三尖瓣环尺寸(7项研究，2,986个科目，-4.1%[95%CI：-7.6%至-0.5%]；P=0.026)，右心房面积（6项研究，1,920名受试者，-1.9%[95%CI：-2.5%至-1.3%]；P<0.001）和死亡率。
结论：RV功能障碍参数与TR患者更差的临床结局相关，而右心房扩张与更好的预后结果相关。需要进一步的研究来解开功能性TR谱内的病理生理学差异。(三尖瓣反流患者的右心重构和转归;CRD42023418667)。
目的：本荟萃分析旨在探讨右心重塑与显著TR患者长期（>1年）全因死亡率之间的关系（至少中度，≥2+)。
方法：MEDLINE，ISIWebofScience,和SCOPUS数据库进行了搜索。研究报告了至少1项RV功能参数和显著TR患者长期全因死亡率的数据。本研究是根据PRISMA（系统审查和荟萃分析的首选报告项目）要求设计的。
结果：在8,902项研究中，总共包括14个，招收4394个科目。所有研究的随访时间各不相同，从最少15.5个月到最多73.2个月不等。总的来说,长期全因死亡率为31%(95%CI:20%-41%;P≤0.001).通过荟萃回归分析，发现三尖瓣环平面收缩期偏移之间存在负相关关系(11项研究纳入3551名受试者，-6.3%[95%CI：-11.1%至-1.4%]；P=0.011)，RV分数面积变化(9项研究，2,975名受试者，-4.4%[95%CI：-5.9%至-2.9%]；P<0.001)，三尖瓣环尺寸(7项研究，2,986个科目，-4.1%[95%CI：-7.6%至-0.5%]；P=0.026)，右心房面积（6项研究，1,920名受试者，-1.9%[95%CI：-2.5%至-1.3%]；P<0.001）和死亡率。
结论：RV功能障碍参数与TR患者更差的临床结局相关，而右心房扩张与更好的预后结果相关。需要进一步的研究来解开功能性TR谱内的病理生理学差异。(三尖瓣反流患者的右心重构和转归;CRD42023418667)。
