Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries.
Echocardiographic Progression of Peak Tricuspid Regurgitant Velocity Among Medicare Beneficiaries.
复制标题
医疗保险受益人三尖瓣反流峰值速度的超声心动图进展。
DOI：
10.1016/j.jacadv.2023.100579
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Strom,JordanB
中科院分区：
文献类型：
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作者：
Kholdani,CyrusA;Choudhary,Gaurav;Furfaro,DavidM;Markson,LawrenceJ;Manning,WarrenJ;Strom,JordanB
BackgroundPeak tricuspid avoidant velocity（TRV）on transthoracic echocardiography（TTE）is a commonly observed parameter and robust predictor of subsequent adverse clinical outcomes.ObjectivesThe purpose of this study was to determine predictors and clinical significance of TRV progress.MethodsWe retrospectively linked consecutive continuous outpatient TTE reports from our institution to 2005 to 2017 Medicare claims.有三尖瓣手术史、心内膜炎、三尖瓣狭窄、TRV值缺失、TTE在住院期间进行或TTEs <2的个体被排除。ResultsA共有4，572例患者（平均年龄67.8 ± 11.9岁，50.4%为女性）接受了13，273次TTE，平均随访时间为7.4（IQR：4.5-6.9）年。TRV平均增加0.23（95% CI：0.22 - 0.23 m/s/y，P< 0.001）（范围：0.01-0.80 m/s/y）。高龄、左室射血分数降低、糖尿病、高血压、高脂血症、心房颤动、心力衰竭和慢性肾脏病与更快的进展相关（均P < 0.05）。考虑到23个人口统计学、临床和TTE变量，TRV进展较快与全因死亡风险逐步增加相关（TRV进展四分位数4 vs 1;校正HR：2.17; 95%CI：1.74-2.71;P< 0.001）。TRV消退的患者（n = 384 [8.4%]）死亡风险较低（校正HR：0.40; 95%CI：0.28-0.57;P< 0.001）.结论在这项对门诊连续TTE的Medicare受益人进行的大型、数十年研究中，TRV进展的平均速率为0.23 m/s/y。年龄较大、左心疾病和不良代谢特征与更快的进展相关。更快的进展与全因死亡的分级风险相关。
BackgroundPeak tricuspid regurgitant velocity (TRV) on transthoracic echocardiography (TTE) is a commonly obtained parameter and robust predictor of subsequent adverse clinical outcomes.ObjectivesThe purpose of this study was to determine the predictors and clinical significance of TRV progression.MethodsWe retrospectively linked consecutive outpatient TTE reports from our institution to 2005 to 2017 Medicare claims. Individuals with prior tricuspid surgery, endocarditis, tricuspid stenosis, missing TRV values, TTEs performed during inpatient hospitalization, or <2 TTEs were excluded.ResultsA total of 4,572 patients (mean age 67.8 ± 11.9 years, 50.4% female) received 13,273 TTEs over a median follow-up of 7.4 (IQR: 4.5-6.9) years. TRV increased by a mean of 0.23 (95% CI: 0.22 to 0.23 m/s/y,P< 0.001) (range, 0.01-0.80 m/s/y). Older age, depressed left ventricular ejection fraction, diabetes, hypertension, hyperlipidemia, atrial fibrillation, heart failure, and chronic kidney disease were associated with faster progression (allP< 0.05). Accounting for 23 demographic, clinical, and TTE variables, faster TRV progression was associated with a stepwise increased risk of all-cause mortality (TRV progression quartile 4 vs 1; adjusted HR: 2.17; 95% CI: 1.74-2.71;P< 0.001). Those with regression of TRV (n = 384 [8.4%]) had a lower mortality risk (adjusted HR: 0.40; 95% CI: 0.28-0.57;P< 0.001).ConclusionsIn this large, multidecade study of Medicare beneficiaries with serial TTEs performed in the outpatient setting, the mean rate of TRV progression was 0.23 m/s/y. Older age, left heart disease, and adverse metabolic features were associated with faster progression. Faster progression was associated with a graded risk for all-cause mortality.