Shiran A, Najjar R, Adawi S, Aronson D. Risk factors for progression of functional tricuspid regurgitation. Am J Cardiol. 2014 Mar 15;113(6):995-1000. PMID: 24461768.

Am J Cardiol. 2014 Mar 15;113(6):995-1000. doi: 10.1016/j.amjcard.2013.11.055. Epub 2013 Dec 25.

Risk factors for progression of functional tricuspid regurgitation.

Shiran A(1), Najjar R(2), Adawi S(3), Aronson D(4).

Author information:
(1)Department of Cardiovascular Medicine Lady Davis Carmel Medical Center, Technion - Israel Institute of Technology, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. Electronic address: av.shiran@gmail.com.
(2)The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
(3)Department of Cardiovascular Medicine Lady Davis Carmel Medical Center, Technion - Israel Institute of Technology, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
(4)Department of Cardiology Rambam Medical Center, Technion - Israel Institute of Technology, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.

The aim of this study was to determine the risk factors for tricuspid regurgitation (TR) progression in a contemporary population of patients referred for echocardiography. In a case-control study, we compared 100 consecutive patients with TR progression on serial echocardiograms (trivial or mild TR on the first echocardiogram and moderate or severe functional TR on a follow-up echocardiogram) with 100 patients matched for age and gender, having mild TR at baseline and no TR progression. Mean age was 72 ± 10 years, 55% were males, and time to TR progression was 5.3 ± 2.9 years. Less than 10% had rheumatic heart disease. Left ventricular ejection fraction was preserved (≥50%) in 85% of the TR progression group and in 74% of the control group (p = 0.06). Pulmonary artery systolic pressure increased from 41 ± 16 to 56 ± 18 mm Hg in the TR progression  group and decreased from 44 ± 13 to 41 ± 11 mm Hg in the control group (p <0.0001). Independent risk factors for TR progression were pulmonary artery systolic pressure change during follow-up (odds ratio per 1 mm Hg 1.14, 95% confidence interval 1.06 to 1.23, p <0.0001), permanent atrial fibrillation (odds ratio 14.3, 95% confidence interval 4.6 to 44.2, p <0.0001), and coronary artery disease (odds ratio 5.7, 95% confidence interval 1.4 to 22.8, p = 0.015). All-cause mortality at 3 years was 20% for patients without TR progression, 42% for moderate TR, and 63% for severe TR, p <0.0001. Progression-to-severe TR independently predicted subsequent mortality. In conclusion, in patients with low prevalence of rheumatic heart disease and preserved left ventricular ejection fraction, pulmonary artery systolic pressure increase and permanent atrial fibrillation were the most powerful risk factors for TR progression. Progression-to-severe TR was an independent predictor of subsequent mortality.

Copyright © 2014 Elsevier Inc. All rights reserved.

PMID: 24461768 [PubMed - indexed for MEDLINE]

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