Baseline Characteristics and Clinical Outcomes of a Tricuspid Regurgitation Referral Population.

Autor: Lawlor MK; Division of Cardiology., Ng V; Division of Cardiology; Structural Heart and Valve Center., Ahmed S; Department of Medicine., Dershowitz L; Department of Medicine., Brener MI; Division of Cardiology., Kampaktsis P; Division of Cardiology., Pitts A; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York., Vahl T; Division of Cardiology; Structural Heart and Valve Center., Nazif T; Division of Cardiology; Structural Heart and Valve Center., Leon M; Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York., George I; Structural Heart and Valve Center; Division of Cardiothoracic & Vascular Surgery, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York., Hahn RT; Division of Cardiology; Structural Heart and Valve Center; Cardiovascular Research Foundation, New York, New York., Kodali S; Division of Cardiology; Structural Heart and Valve Center. Electronic address: sk2427@cumc.columbia.edu.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Jun 01; Vol. 196, pp. 22-30. Date of Electronic Publication: 2023 Apr 12.
DOI: 10.1016/j.amjcard.2023.03.011
Abstrakt: Adverse outcomes in tricuspid regurgitation (TR) have been associated with advanced regurgitation severity and right-sided cardiac remodeling, and late referrals for tricuspid valve surgery in TR have been associated with increase in postoperative mortality. The purpose of this study was to evaluate baseline characteristics, clinical outcomes, and procedural utilization of a TR referral population. We analyzed patients with a diagnosis of TR referred to a large TR referral center between 2016 and 2020. We evaluated baseline characteristics stratified by TR severity and analyzed time-to-event outcomes for a composite of overall mortality or heart-failure hospitalization. In total, 408 patients were referred with a diagnosis of TR: the median age of the cohort was 79 years (interquartile range 70 to 84), and 56% were female. In patients evaluated on a 5-grade scale, 10.2% had ≤moderate TR; 30.7% had severe TR; 11.4% had massive TR, and 47.7% had torrential TR. Increasing TR severity was associated with right-sided cardiac remodeling and altered right ventricular hemodynamics. In multivariable Cox regression analysis, New York Heart Association class symptoms, history of heart failure hospitalization, and right atrial pressure were associated with the composite outcome. One-third of patients referred underwent transcatheter tricuspid valve intervention (19%) or surgery (14%); patients who underwent transcatheter tricuspid valve intervention had greater preoperative risk than that of patients who underwent surgery. In conclusion, in patients referred for evaluation of TR, there were high rates of massive and torrential regurgitation and advanced right ventricle remodeling. Symptoms and right atrial pressure are associated with clinical outcomes in follow-up. There were significant differences in baseline procedural risk and eventual therapeutic modality.
Competing Interests: Disclosures Dr. Lawlor declares institutional funding to Columbia University Irving Medical Center from Edwards Lifesciences and personal consulting fees from Osprey Medical. Dr. Brener is funded by the ACC/Merck Research Fellowship and reports institutional funding to Columbia University Irving Medical Center from Abiomed and personal consulting fees from Artract Medical and Osprey Medical. Dr. Vahl declares institutional funding to Columbia University Irving Medical Center from Boston Scientific, Edwards Lifesciences, JenaValve, Medtronic (Abbott), and Siemens Healthineers, and he personally received consulting fees from Abbott Vascular, Boston Scientific, and Siemens Healthineers. Dr. Nazif declares consulting or honoraria for Edwards Lifesciences, Medtronic, Venus Medtech, and Boston Scientific. Dr. Leon declares institutional clinical research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and JenaValve. Dr. George declares consulting fees from Vdyne, CardioMech, Mitremedical, MITrx, Durvena, and Foldax. Dr. Hahn declares speaker fees from Abbott Structural, Baylis Medical, Edwards Lifesciences, and Philips Healthcare; institutional consulting contracts for which she receives no direct compensation with Abbott Structural, Boston Scientific, Edwards Lifesciences, Medtronic, and Novartis; stock options with Navigate; and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr. Kodali declares being a consultant (honoraria) for Admedus, Meril Lifesciences, JenaValve, Abbott Vascular; serving on scientific advisory boards (equity) for Dura Biotech, MicroInterventional Devices, Thubrikar Aortic Valve Inc., Supira, and Admedus; and receiving institutional funding to Columbia University and/or Cardiovascular Research Foundation from Edwards Lifesciences, Medtronic Vascular, Boston Scientific, and JenaValve. The remaining authors have no conflicts of interest to declare.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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