背景:基于超声心动图的心房功能性三尖瓣反流(A-FTR)的新定义在接受保守治疗或三尖瓣经导管边缘到边缘修复的患者中显示出优异的结果。其对经导管三尖瓣瓣环成形术(TTVA)预后的意义尚不清楚。
目的:本研究旨在调查预后,临床,以及TTVA患者A-FTR表型的技术意义。
方法:这项多中心研究调查了165例连续接受TTVA治疗A-FTR的患者长达1年的临床和超声心动图结果(其特征是没有三尖瓣隆起,右心室[RV]扩张,和左心室射血分数受损)和非心房功能性三尖瓣反流(NA-FTR)。
结果:共确定了62例A-FTR和103例NA-FTR患者,后者表现出更明显的RV重塑。与基线相比,出院时三尖瓣反流(TR)分级显著降低(两种亚型P<0.001),在A-FTR中,TR≤II的频率更高(85.2%vs60.8%;P=0.001)。基线TR分级和A-FTR表型与出院时和30天的TR≤II独立相关。在多变量分析中,A-FTR表型是30天时TR≤II的强预测因子(OR:5.8;95%CI:2.1-16.1;P<0.001)。在1年,功能分级与基线相比有显著改善(均P<0.001).A-FTR的一年死亡率较低(6.5%vs23.8%;P=0.011),心力衰竭住院率无显著差异(13.3%vs22.7%;P=0.188)。
结论:直接TTVA可有效降低A-FTR中的TR,这是实现TR≤II的强大且独立的预测因子,和NA-FTR。即使NA-FTR在基线显示更多的RV重塑,两种表型都经历了相似的症状改善,强调TTVA的好处,即使在晚期疾病阶段。此外,表型与接受TTVA的患者预后相关。
BACKGROUND: A novel echocardiography-based definition of atrial functional tricuspid regurgitation (A-FTR) has shown superior outcomes in patients undergoing conservative treatment or tricuspid valve transcatheter edge-to-edge repair. Its prognostic significance for transcatheter tricuspid valve annuloplasty (TTVA) outcomes is unknown.
OBJECTIVE: This study sought to investigate prognostic, clinical, and technical implications of A-FTR phenotype in patients undergoing TTVA.
METHODS: This multicenter study investigated clinical and echocardiographic outcomes up to 1 year in 165 consecutive patients who underwent TTVA for A-FTR (characterized by the absence of tricuspid valve tenting, midventricular right ventricular [RV] dilatation, and impaired left ventricular ejection fraction) and nonatrial functional tricuspid regurgitation (NA-FTR).
RESULTS: A total of 62 A-FTR and 103 NA-FTR patients were identified, with the latter exhibiting more pronounced RV remodeling. Compared to baseline, the tricuspid regurgitation (TR) grade at discharge was significantly reduced (P < 0.001 for both subtypes), and TR ≤II was achieved more frequently in A-FTR (85.2% vs 60.8%; P = 0.001). Baseline TR grade and A-FTR phenotype were independently associated with TR ≤II at discharge and 30 days. In multivariate analyses, A-FTR phenotype was a strong predictor (OR: 5.8; 95% CI: 2.1-16.1; P < 0.001) of TR ≤II at 30 days. At 1 year, functional class had significantly improved compared to baseline (both P < 0.001). One-year mortality was lower in A-FTR (6.5% vs 23.8%; P = 0.011) without significant differences in heart failure hospitalizations (13.3% vs 22.7%; P = 0.188).
CONCLUSIONS: Direct TTVA effectively reduces TR in both A-FTR, which is a strong and independent predictor of achieving TR ≤II, and NA-FTR. Even though NA-FTR showed more RV remodeling at baseline, both phenotypes experienced similar symptomatic improvement, emphasizing the benefit of TTVA even in advanced disease stages. Additionally, phenotyping was of prognostic relevance in patients undergoing TTVA.