Abstract：
Rheumatic heart disease (RHD) is still a major health problem, especially in low- to mid-income countries, leading premature deaths owing to valvular disease. Although left-sided valvular involvement is most commonly seen in RHD, the tricuspid valve can also be affected. However, there is a lack of information about the prognostic value of primary tricuspid valve (TV) disease in RHD. This study aimed to determine the impact of TV disease on clinical outcome in RHD. This prospective study enrolled patients with rheumatic mitral valve disease (MVD) referred to a tertiary center for management of heart valve disease. Primary rheumatic TV disease was defined by echocardiographic features including thickening of leaflets associated with some degree of restricted mobility. Patients with rheumatic TV disease were matched to patients with MVD using 1:1 genetic matching algorithm that maximized balance of baseline covariates prior to exploring outcome differences. The main outcome was either need for MV replacement or death. Among 694 patients eligible for the study, age of 47 ± 13 years, 84% female, 39 patients (5.6%) had rheumatic TV disease. After excluding patients with incomplete data, 33 patients with TV disease were matched to 33 controls based on age, right-sided heart failure, atrial fibrillation, and MV area. During a mean follow-up of 42 months (median 28, IQR 8 to 71 months), 32 patients (48.5%) experienced adverse events, including 6 cardiovascular deaths and 26 patients who underwent surgery for mitral valve replacement. The adjusted analysis demonstrated a significant association between TV disease and the outcome, with a hazard ratio (HR) of 3.386 (95% CI 1.559-7.353; P = 0.002) in the genetic matched cohort with balance on baseline covariates of interest. The model exhibited good discriminative ability, as indicated by a C-statistic of 0.837. In patients with rheumatic mitral valve disease, rheumatic TV disease significantly increased risk of adverse events compared with matched controls. The involvement of TV may express overall disease severity that adversely affects clinical outcome.
摘要：
风湿性心脏病（RHD）仍然是一个主要的健康问题，尤其是在中低收入国家，由于瓣膜疾病导致的过早死亡。尽管左侧瓣膜受累最常见于RHD，三尖瓣也可能受到影响。然而,缺乏有关原发性三尖瓣（TV）疾病在RHD中的预后价值的信息。本研究旨在确定TV病对RHD临床结局的影响。这项前瞻性研究纳入了风湿性二尖瓣疾病（MVD）患者，该患者转诊至三级心脏瓣膜疾病管理中心。原发性风湿性TV疾病由超声心动图特征定义，包括与一定程度的活动受限相关的小叶增厚。使用1：1遗传匹配算法将风湿性TV疾病患者与MVD患者进行匹配，该算法在探索结果差异之前最大化了基线协变量的平衡。主要结果是需要更换MV或死亡。在694名符合研究条件的患者中，年龄47±13岁，84%女性，39例患者（5.6％）患有风湿性TV疾病。排除数据不完整的患者后，33例TV病患者根据年龄与33例对照相匹配，右侧心力衰竭,心房颤动,MV区。在平均42个月的随访期间(中位数28，IQR8至71个月)，32例患者（48.5%）出现不良事件，包括6例心血管死亡和26例接受二尖瓣置换术的患者。调整后的分析表明，电视疾病与结局之间存在显着关联，风险比（HR）为3.386（95％CI1.559-7.353;P=0.002）在遗传匹配队列中，基线协变量平衡。该模型表现出良好的判别能力，如0.837的C统计量所示。风湿性二尖瓣疾病患者，与匹配的对照组相比,风湿性TV疾病的不良事件风险显著增加.TV的参与可能表达对临床结果产生不利影响的总体疾病严重程度。
