Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair
Right Ventricular-Pulmonary Arterial Coupling and Afterload Reserve in Patients Undergoing Transcatheter Tricuspid Valve Repair
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DOI：
10.1016/j.jacc.2021.11.031
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发表时间：
2022-01-31
影响因子：
24
通讯作者：
Hahn, Rebecca T.
中科院分区：
文献类型：
--
作者：
Brener, Michael, I;Lurz, Philipp;Hahn, Rebecca T.
背景右心室(RV)-肺动脉（PA）耦合比与右心室卒中功传递到右心室的效率有关。较低的比率表明后负荷增加后右心室收缩反应不足。目的：本研究旨在评估经导管三尖瓣修复或置换术（TTVR）的三尖瓣反流（TR）患者RV-PA耦合的预后意义。研究人员通过术前和术后30天经胸超声心动图的三尖瓣环平面收缩偏移（TAPSE）除以PA收缩压（PASP），计算了全球TriValve注册患者的RV-PA耦合比。主要终点是1年随访时的全因死亡率。结果444例患者的平均年龄为76.9±9.1岁，女性占53.8%。中位TAPSE/PASP比值为0.406 mm/mm Hg（四分位数范围：0.308-0.567 mm/mm Hg）。63例患者在TTVR 1年内死亡，其中21例患者的TAPSE/PASP比值为0.406,42例患者的TAPSE/PASP比值为0.406。在多变量Cox回归分析中，TAPSE/PASP比值>0.406 vs .0.406与全因死亡风险降低相关（HR: 0.57; 95% CI: 0.35-0.93; P = 0.023）。在234例（52.7%）TTVR后30天超声心动图的患者中，RV-PA耦合的下降与全因死亡率的降低独立相关（优势比[OR]: 0.42; 95% CI: 0.19-0.93; P = 0.032）。TTVR后TR降低幅度（1+ vs . 1+）
BACKGROUND The right ventricular (RV)-pulmonary arterial (PA) coupling ratio relates the efficiency with which RV stroke work is transferred into the PA. Lower ratios indicate an inadequate RV contractile response to increased afterload. OBJECTIVES This study sought to evaluate the prognostic significance of RV-PA coupling in patients with tricuspid regurgitation (TR) who were undergoing transcatheter tricuspid valve repair or replacement (TTVR). METHODS The study investigators calculated RV-PA coupling ratios for patients enrolled in the global TriValve registry by dividing the tricuspid annular plane systolic excursion (TAPSE) by the PA systolic pressure (PASP) from transthoracic echocardiograms performed before the procedure and 30 days after the procedure. The primary endpoint was all-cause mortality at 1-year follow-up. RESULTS Among 444 patients analyzed, their mean age was 76.9 +/- 9.1 years, and 53.8% of the patients were female. The median TAPSE/PASP ratio was 0.406 mm/mm Hg (interquartile range: 0.308-0.567 mm/mm Hg). Sixty-three patients died within 1 year of TTVR, 21 with a TAPSE/PASP ratio >0.406 and 42 with a TAPSE/PASP ratio .0.406. In multivariable Cox regression analysis, a TAPSE/PASP ratio >0.406 vs .0.406 was associated with a decreased risk of all cause mortality (HR: 0.57; 95% CI: 0.35-0.93; P = 0.023). In 234 (52.7%) patients with echocardiograms 30 days after TTVR, a decline in RV-PA coupling was independently associated with reduced odds of all-cause mortality (odds ratio [OR]: 0.42; 95% CI: 0.19-0.93; P = 0.032). The magnitude of TR reduction after TTVR ($1+ vs