Prevalence, Incidence, and Outcomes of Diastolic Dysfunction in Isolated Tricuspid Regurgitation: Perhaps Not Really "Isolated"?

Autor:	Naser JA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Harada T; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Tada A; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Doi S; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Tsaban G; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Pislaru SV; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Nkomo VT; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Scott CG; Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA., Kennedy AM; Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA., Eleid MF; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Reddy YNV; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Lin G; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Pellikka PA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Borlaug BA; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Borlaug.Barry@mayo.edu.
Jazyk:	angličtina
Zdroj:	JACC. Cardiovascular imaging [JACC Cardiovasc Imaging] 2024 Dec; Vol. 17 (12), pp. 1411-1424. Date of Electronic Publication: 2024 Jul 24.
DOI:	10.1016/j.jcmg.2024.05.019
Abstrakt:	Background: In the absence of left-sided cardiac/pulmonary disease, functional tricuspid regurgitation (FTR) is referred to as isolated or idiopathic. Relationships between left ventricular diastolic dysfunction (DD) and FTR remain unknown. Objectives: The purpose of this study was to investigate the prevalence, incidence, and outcome of DD in patients with idiopathic FTR. Methods: Adults without structural heart disease were identified. Severe DD was defined by ≥3 of 4 abnormal DD parameters (medial e', medial E/e', TR velocity, left atrial volume index) and ≥ moderate DD by ≥2. Propensity-score matching was performed (3:1) between each less-than-severe TR group and severe TR based on age, sex, body mass index, and comorbidities. Results: Among 30,428 patients, FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. In the propensity-matched sample, severe DD was present in 2%, 6%, 9%, and 13% patients, and ≥ moderate DD in 11%, 18%, 28%, and 48%, respectively (P < 0.001). The probability of heart failure with preserved ejection fraction using the H 2 FPEF score increased with increasing FTR (median 29.7%, 45.5%, 61.4%, and 88.7%, respectively), as did the prevalence of impaired left atrial strain <24% (35%, 48%, and 69% in mild, moderate, and severe TR). Incident severe and ≥ moderate DD developed more frequently with increasing FTR (HR: 8.45 [95% CI: 2.60-27.50] and HR: 2.82 [95% CI: 1.40-5.69], respectively for ≥ moderate vs no FTR) over a median of 3.0 years. Findings were confirmed in patients without lung disease or right ventricular enlargement. Over a median of 5.0 years, patients with ≥ moderate FTR and DD had the greatest risk of worse outcomes (multivariable P < 0.001). The association between TR and adverse outcomes was significantly diminished in the absence of DD. Conclusions: Diastolic dysfunction, increased heart failure with preserved ejection fraction probability, and impaired left atrial strain are commonly present in patients with idiopathic FTR, suggesting that the latter may not be truly isolated. Patients with FTR without DD or heart failure are at increased risk of incident DD. Patients with FTR and DD display worse outcomes. Competing Interests: Funding Support and Author Disclosures Dr Reddy is supported by National Heart, Lung, and Blood Institute of the National Institutes of Health Award Number K23HL164901; has received grants from Sleep Number, Bayer, and United pharmaceuticals; and has received the Earl Wood Career Development Award from Mayo Clinic. Dr Pellikka is supported as the Betty Knight Scripps Professor of Cardiovascular Disease Clinical Research, Mayo Clinic. Dr Borlaug is supported in part by National Institutes of Health grants R01 HL128526, R01 HL162828, and U01 HL160226, and by W81XWH2210245 from the U.S. Department of Defense. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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