Tricuspid Regurgitation is Associated With Increased Risk of Mortality in Patients With Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction Results of the Multicenter TOPAS Study (True or Pseudo-Severe Aortic Stenosis)

被引:56
作者
Dahou, Abdellaziz [1 ]
Magne, Julien [2 ,3 ]
Clavel, Marie-Annick [1 ]
Capoulade, Romain [1 ]
Bartko, Philipp Emanuel [4 ]
Bergler-Klein, Jutta [4 ]
Senechal, Mario [1 ]
Mundigler, Gerald [4 ]
Burwash, Ian [5 ]
Ribeiro, Henrique B. [1 ]
O'Connor, Kim [1 ]
Mathieu, Patrick [1 ]
Baumgartner, Helmut [6 ]
Dumesnil, Jean G. [1 ]
Rosenhek, Raphael [4 ]
Larose, Eric [1 ]
Rodes-Cabau, Josep [1 ]
Pibarot, Philippe [1 ]
机构
[1] Univ Laval, Quebec Heart & Lung Inst, Inst Univ Cardiol & Pneumol Quebec, Dept Cardiol, Quebec City, PQ, Canada
[2] Ctr Hosp Univ Limoges, Hop Dupuytren, Dept Cardiol, Limoges, France
[3] Fac Med Limoges, INSERM 1094, F-87025 Limoges, France
[4] Med Univ Vienna, Div Cardiol, Dept Internal Med 2, Vienna, Austria
[5] Univ Ottawa, Inst Heart, Dept Cardiol, Ottawa, ON, Canada
[6] Univ Hosp Muenster, Dept Cardiovasc Med, Div Adult Congenital & Valvular Heart Dis, Munster, Germany
基金
加拿大健康研究院;
关键词
aortic stenosis; aortic valve replacement; echocardiography; low-flow; low-gradient; outcome; tricuspid regurgitation; PROJECTED VALVE AREA; MITRAL REGURGITATION; EUROPEAN ASSOCIATION; CONTRACTILE RESERVE; AMERICAN-SOCIETY; REPLACEMENT; IMPACT; ECHOCARDIOGRAPHY; RECOMMENDATIONS; PREDICTORS;
D O I
10.1016/j.jcin.2014.08.019
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study sought to examine the impact of tricuspid regurgitation (TR) on mortality in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF). BACKGROUND TR is often observed in patients with LF-LG AS and low LVEF, but its impact on prognosis remains unknown. METHODS A total of 211 patients (73 +/- 10 years of age; 77% men) with LF-LG AS (mean gradient <40 mm Hg and indexed aortic valve area [AVA] <= 0.6 cm(2)/m(2)) and reduced LVEF (<= 40%) were prospectively enrolled in the TOPAS (True or Pseudo-Severe Aortic Stenosis) study and 125 (59%) of them underwent aortic valve replacement (AVR) within 3 months following inclusion. The severity of AS was assessed by the projected AVA (AVA(proj)) at normal flow rate (250 ml/s), as previously described and validated. The severity of TR was graded according to current guidelines. RESULTS Among the 211 patients included in the study, 22 (10%) had no TR, 113 (54%) had mild (grade 1), 50 (24%) mild-to-moderate (grade 2), and 26 (12%) moderate-to-severe (grade 3) or severe (grade 4) TR. During a mean follow-up of 2.4 +/- 2.2 years, 104 patients (49%) died. Univariable analysis showed that TR >= 2 was associated with increased risk of all-cause mortality (hazard ratio [HR]: 1.82, 95% confidence interval [CI]: 1.22 to 2.71; p = 0.004) and cardiovascular mortality (HR: 1.85, 95% CI: 1.20 to 2.83; p = 0.005). After adjustment for age, sex, coronary artery disease, AVAproj, LVEF, stroke volume index, right ventricular dysfunction, mitral regurgitation, and type of treatment (AVR vs. conservative), the presence of TR >= 2 was an independent predictor of all-cause mortality (HR: 1.88, 95% CI: 1.08 to 3.23; p = 0.02) and cardiovascular mortality (HR: 1.92, 95% CI: 1.05 to 3.51; p = 0.03). Furthermore, in patients undergoing AVR, TR >= 3 was an independent predictor of 30-day mortality compared with TR = 0/1 (odds ratio [OR]: 7.24, 95% CI: 1.56 to 38.2; p = 0.01) and TR = 2 (OR: 4.70, 95% CI: 1.00 to 25.90; p = 0.05). CONCLUSIONS In patients with LF-LG AS and reduced LVEF, TR is independently associated with increased risk of cumulative all-cause mortality and cardiovascular mortality regardless of the type of treatment. In patients undergoing AVR, moderate/severe TR is associated with increased 30-day mortality. Further studies are needed to determine whether TR is a risk marker or a risk factor of mortality and whether concomitant surgical correction of TR at the time of AVR might improve outcomes for this high-risk population. (C) 2015 by the American College of Cardiology Foundation.
引用
收藏
页码:588 / 596
页数:9
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