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
{"title":"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","authors":"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","doi":"10.1016/j.acvdsp.2023.04.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>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.</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 < 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 < 10<!--> <!-->mm (53<!--> <!-->±<!--> <!-->7% vs. 69<!--> <!-->±<!--> <!-->3%, <em>P</em> <!--><<!--> <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. A TCG ≥ 10<!--> <!-->mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated functional TR (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":null,"pages":null},"PeriodicalIF":18.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"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\",\"doi\":\"10.1016/j.acvdsp.2023.04.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><p>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.</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 < 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 < 10<!--> <!-->mm (53<!--> <!-->±<!--> <!-->7% vs. 69<!--> <!-->±<!--> <!-->3%, <em>P</em> <!--><<!--> <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. A TCG ≥ 10<!--> <!-->mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated functional TR (<span>Fig. 1</span>).</p></div>\",\"PeriodicalId\":8140,\"journal\":{\"name\":\"Archives of Cardiovascular Diseases Supplements\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":18.0000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Cardiovascular Diseases Supplements\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1878648023001477\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases Supplements","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1878648023001477","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
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).
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.