■随着人口老龄化和先进的导管治疗,孤立性三尖瓣反流(TR)伴心房颤动(AF)已得到越来越多的关注;然而,由于重度TR患者中的患者数量较少,因此关于孤立性TR合并AF的预后效果的数据有限.最近,据报道,二维斑点追踪超声心动图的右心室(RV)纵向应变是严重TR患者RV功能障碍的一个很好的指标.然而,RV纵向劳损在与AF相关的孤立性严重TR中的预后意义尚不清楚.因此,本研究旨在揭示该指标在该人群中的预后价值。
■我们回顾性研究了2015年4月至2018年3月在Cedars-Sinai医学中心无其他病因情况下与房颤相关的严重孤立性TR患者。研究了基线临床和超声心动图数据,包括通过RV游离壁纵向应变(FWLS)和常规参数评估的RV收缩功能。全因死亡被定义为主要终点。
■总共,53例患者(中位年龄,85岁;女性,60%),中位随访时间为433(60-1567)天。14名患者(26%)死亡,66%有右心衰竭(RHF)症状。通过多变量分析,RVFWLS降低与全因死亡独立相关.RVFWLS≤18%的患者根据年龄调整后的全因死亡风险较高(log-rankP=0.030,调整后的风险比4.00,95%置信区间,1.11-14.4;P=0.034)。当根据RHF症状和RVFWLS将患者分为四组时,有症状和RVFWLS降低的组的结局最差.
■RVFWLS降低与孤立性严重TR和AF患者的全因死亡独立相关。我们的子集分类显示了RHF症状和RVFWLS减少的组合的最差结果。
UNASSIGNED: With the aging population and advanced catheter-based therapy, isolated tricuspid regurgitation (TR) with atrial fibrillation (AF) has gained increased attention; however, data on the prognostic effect of isolated TR with AF are limited because of the small number of patients among those with severe TR. Recently, right ventricular (RV) longitudinal strain by two-dimensional speckle-tracking echocardiography has been reported as an excellent indicator of RV dysfunction in severe TR. However, the prognostic implications of RV longitudinal strain in isolated severe TR associated with AF remain unclear. Therefore, this study aimed to reveal the prognostic value of this index in this population.
UNASSIGNED: We retrospectively studied patients with severe isolated TR associated with AF in the absence of other etiologies in the Cedars-Sinai Medical Center between April 2015 and March 2018. Baseline clinical and echocardiographic data were studied including RV systolic function evaluated by RV free wall longitudinal strain (FWLS) and conventional parameters. All-cause death was defined as the primary endpoint.
UNASSIGNED: In total, 53 patients (median age, 85 years; female, 60%) with a median follow-up of 433 (60-1567) days were included. Fourteen patients (26%) died, and 66% had right heart failure (RHF) symptoms. By multivariable analysis, reduced RVFWLS was independently associated with all-cause death. Patients with RVFWLS of ≤18% had higher risk of all-cause death adjusted for age (log-rank P = 0.030, adjusted hazard ratio 4.00, 95% confidence interval, 1.11-14.4; P = 0.034). When patients were stratified into four groups by RHF symptoms and RVFWLS, the group with symptomatic and reduced RVFWLS had the worst outcome.
UNASSIGNED: Reduced RVFWLS was independently associated with all-cause death in patients with isolated severe TR and AF. Our subset classification showed the worst outcome from the combination of RHF symptoms and reduced RVFWLS.