比较PISA法和三尖瓣适应间隙测量的有效返流孔面积,以识别非常严重的三尖瓣返流并分层死亡风险

L. Tordjman , Y. Bohbot , J. Dreyfus , T. Le Tourneau , Y. Lavie-Badie , C. Selton-Suty , B. Elegamandji , G. L’official , A. Fraix , S. Aghezzaf , P.Y. Turgeon , D. Messika Zeitoun , M. Enriquez-Sarano , A. Coisne , E. Donal , C. Tribouilloy
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Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.</p></div><div><h3>Method</h3><p>In this French multicentre retrospective study, we included 606 patients with ≥ moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥ 60 mm<sup>2</sup>) and then according to the TCG (≥ 10<!--> <span>mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.</span></p></div><div><h3>Results</h3><p>The relationship between the EROA and TCG was poor (R<sup>2</sup> <!-->=<!--> <!-->0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA &lt; 60 mm<sup>2</sup> vs. ≥ 60 mm<sup>2</sup> (68<!--> <!-->±<!--> <!-->3% vs. 64<!--> <!-->±<!--> <!-->5%, <em>P</em> <!-->=<!--> <!-->0.89). A TCG ≥ 10<!--> <!-->mm was associated with lower four-year survival than a TCG &lt; 10<!--> <!-->mm (53<!--> <!-->±<!--> <!-->7% vs. 69<!--> <!-->±<!--> <!-->3%, <em>P</em> <!-->&lt;<!--> <span>0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥ 10</span> <!-->mm remained independently associated with higher all-cause mortality (adjusted HR [95%CI]<!--> <!-->=<!--> <!-->1.47 [1.13–2.21], <em>P</em> <!-->=<!--> <!-->0.019) and cardiovascular mortality (adjusted HR [95%CI]<!--> <!-->=<!--> <!-->2.12 [1.33–3.25], <em>P</em> <!-->=<!--> <!-->0.001), whereas an EROA ≥ 60 mm<sup>2</sup> was not associated with all-cause or cardiovascular mortality (adjusted HR [95%CI]: 1.16 [0.81–1.64], <em>P</em> <!-->=<!--> <!-->0.416, and adjusted HR [95%CI]: 1.07 [0.68–1.68], <em>P</em> <!-->=<!--> <!-->0.784, respectively).</p></div><div><h3>Conclusion</h3><p>The correlation between the TCG and EROA is weak and decreases with increasing defect size. 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引用次数: 0

摘要

根据有效反流口面积(EROA)或三尖瓣接合间隙(TCG),已经提出了非常严重(VS)三尖瓣反流(TR)的各种定义。由于EROA的固有局限性,我们假设TCG更适合定义VSTR和预测结果。方法在这项法国多中心回顾性研究中,根据欧洲心血管成像协会的建议,我们纳入了606名≥中度至重度孤立性功能性TR(无结构性瓣膜病或明显的心脏原因)的患者。根据EROA(≥60mm2)和TCG(≥10mm)将患者进一步分为VSTR。主要终点是全因死亡率,次要终点是心血管死亡率。结果EROA与TCG的相关性较差(R2=0.22),尤其是当缺损尺寸较大时。EROA<;60 mm2 vs.≥60 mm2(68±3%vs.64±5%,P=0.89)。TCG≥10 mm与TCG<;10mm(53±7%对69±3%,P<;0.001)。在校正协变量后,包括合并症、症状、利尿剂剂量以及右心室扩张和功能障碍,TCG≥10 mm与较高的全因死亡率(调整后的HR[95%CI]=1.47[1.13–2.21],P=0.019)和心血管死亡率(调整前的HR[95%CI]=2.12[1.33–3.25],P=0.001)仍独立相关,EROA≥60mm2与全因或心血管死亡率无关(校正后HR[95%CI]:1.16[0.81–1.64],P=0.416,校正后HR:95%CI]:10.77[0.68–1.68],P=0.784)。TCG≥10mm与全因和心血管死亡率增加有关,应用于定义孤立功能性TR中的VSTR(图1)。
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Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk

Introduction

Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes.

Method

In this French multicentre retrospective study, we included 606 patients with ≥ moderate-to-severe isolated functional TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥ 60 mm2) and then according to the TCG (≥ 10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality.

Results

The relationship between the EROA and TCG was poor (R2 = 0.22), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA < 60 mm2 vs. ≥ 60 mm2 (68 ± 3% vs. 64 ± 5%, P = 0.89). A TCG ≥ 10 mm was associated with lower four-year survival than a TCG < 10 mm (53 ± 7% vs. 69 ± 3%, P < 0.001). After adjustment for covariates, including comorbidity, symptoms, dose of diuretics, and right ventricular dilatation and dysfunction, a TCG ≥ 10 mm remained independently associated with higher all-cause mortality (adjusted HR [95%CI] = 1.47 [1.13–2.21], P = 0.019) and cardiovascular mortality (adjusted HR [95%CI] = 2.12 [1.33–3.25], P = 0.001), whereas an EROA ≥ 60 mm2 was not associated with all-cause or cardiovascular mortality (adjusted HR [95%CI]: 1.16 [0.81–1.64], P = 0.416, and adjusted HR [95%CI]: 1.07 [0.68–1.68], P = 0.784, respectively).

Conclusion

The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥ 10 mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated functional TR (Fig. 1).

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来源期刊
Archives of Cardiovascular Diseases Supplements
Archives of Cardiovascular Diseases Supplements CARDIAC & CARDIOVASCULAR SYSTEMS-
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期刊介绍: Archives of Cardiovascular Diseases Supplements is the official journal of the French Society of Cardiology. The journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles, editorials, and Images in cardiovascular medicine. The topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Additionally, Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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