Impact of Right Ventricular Dysfunction and Tricuspid Regurgitation on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
Impact of Right Ventricular Dysfunction and Tricuspid Regurgitation on Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement
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DOI：
10.1016/j.echo.2016.08.016
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发表时间：
2017-01-01
影响因子：
6.5
通讯作者：
Topilsky, Yan
中科院分区：
文献类型：
--
作者：
Schwartz, Lorin Arie;Rozenbaum, Zach;Topilsky, Yan
背景：右心室（RV）功能障碍和三尖瓣反流（TR）可能与主动脉瓣狭窄并存。本研究的目的是评估右心室功能障碍、TR、相关合并症和经导管主动脉瓣置换术 (TAVR) 后结局之间的关联。方法：对基线和 6 个月的临床和超声心动图参数进行回顾性分析，包括 TR 等级、右心室大小（等级、舒张末期和收缩末期面积、瓣环直径）和功能 （等级、三尖瓣环平面收缩期偏移 [TAPSE]、面积变化分数、Tei 指数），在 519 名连续 TAVR 患者中进行。结果：中度或以上 TR 的患病率为 11% (n = 59)。尽管在未经调整的分析中 TR 与死亡率增加相关 (P = 0.02)，但在调整 RV 功能障碍 (TAPSE；P = 0.30) 或多个临床参数 (P > = 0.20) 时，它并未证明与结果存在独立关联。与不良结果相关的 RV 参数包括 TAPSE (P = .006) 和 Tei 指数 (P = .005)。即使调整了 TR (P = .009) 和所有临床参数 (P = .01)，TAPSE 仍与较低的生存率相关。 TAVR 后 6 个月持续中度或更大的 TR 似乎与较低的生存率相关 (P = .02)，即使根据临床和 RV 参数进行调整 (P = .07)。结论：尽管进行了 TAVR，与主动脉瓣狭窄相关的 TR 仍经常进展，但与结果并不独立相关。与 TR 本身相比，RV 功能是不良结果的更强驱动因素，RV 定量而非定性评估是对这些患者进行分层的关键。
Background: Right ventricular (RV) dysfunction and tricuspid regurgitation (TR) may coexist with aortic stenosis. The aim of this study was to assess the association between RV dysfunction, TR, associated comorbidities, and outcomes following transcatheter aortic valve replacement (TAVR).Methods: A retrospective analysis was conducted of baseline and 6-month clinical and echocardiographic parameters, including TR grade, RV size (grade, end-diastolic and end-systolic areas, annular diameter), and function (grade, tricuspid annular plane systolic excursion [TAPSE], fractional area change, Tei index), in 519 consecutive TAVR patients.Results: The prevalence of moderate or greater TR was 11% (n = 59). Although TR was associated with increased mortality (P =.02) in unadjusted analysis, it did not demonstrate an independent association with outcome when adjusted for RV dysfunction (TAPSE; P =.30) or multiple clinical parameters (P >= .20). RV parameters associated with poor outcomes included TAPSE (P = .006) and Tei index (P = .005). TAPSE was associated with lower survival even when adjusted for TR (P = .009) and all clinical parameters (P = .01). Persistence of moderate or greater TR 6 months after TAVR seemed to be associated with lower survival (P =.02), even when adjusted for clinical and RV parameters (P = .07).Conclusions: TR in association with aortic stenosis is frequently progressive despite TAVR but is not independently associated with outcomes. RV function is a stronger driver of adverse outcomes compared with TR itself, and RV quantitative rather than qualitative evaluation is the key to stratify these patients.