论文标题：The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

期刊： Frontiers of Medicine

作者：Kevin M. Veen, Grigorios Papageorgiou, Casper F. Zijderhand, Mostafa M. Mokhles, Jasper J. Brugts, Olivier C. Manintveld, Alina A. Constantinescu, Jos A. Bekkers, Johanna J.M. Takkenberg, Ad J.J.C. Bogers, Kadir Caliskan

发表时间：15 Jun 2023

DOI：10.1007/s11684-022-0967-5

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导 读

荷兰伊拉斯谟大学医学中心Kadir Caliskan博士等在Frontiers of Medicine发表研究论文《双心房原位心脏移植患者三尖瓣反流的临床影响》（The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant）。本文研究了双心房原位心脏移植（OHT）后三尖瓣反流（TR）的临床影响和长期进程。研究发现随访期间中度至重度TR与更高死亡率、肾功能恶化显著相关，且TR概率在OHT后立即达到最高，随后降低，这表明早期或不宜进行手术干预。

In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984−2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02–1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.

本研究旨在阐明双心房原位心脏移植（OHT）后，动态变化的三尖瓣反流（TR）的临床影响和长期病程。研究纳入了1984年至2017年间接受双心房OHT且有可用随访超声心动图检查结果的成年患者。采用混合模型来模拟TR的进展情况。将该混合模型纳入Cox比例风险模型中，以探讨动态变化的TR与死亡率之间的关联。研究共纳入了572例患者（中位年龄50岁，男性占74.9%）。约32%的患者在术后即刻出现了中度至重度的TR。然而，在校正生存偏倚后，术后5年这一比例降至11%，术后10年降至9%。术前机械支持与随访期间更低的TR发生率相关，而同时存在的左心室功能障碍则与随访期间更高的TR发生率显著相关。患者1年、5年、10年和20年的生存率分别为97% ± 1%、88% ± 1%、66% ± 2%和23% ± 2%。随访期间存在中度至重度TR与较高的死亡率相关（风险比1.07，95%置信区间1.02-1.12，p = 0.006）。TR的病程与血肌酐的变化呈正相关（R = 0.45）。随访期间的TR与较高的死亡率和较差的肾功能显著相关。尽管如此，TR的发生概率在OHT后即刻最高，随后逐渐降低。因此，在OHT后的早期阶段避免对TR进行手术干预可能是合理的。

期刊介绍

Frontiers of Medicine专注于发表临床医学和基础医学领域的最新研究成果，旨在通过全球医疗专业人员之间的交流促进健康和医疗保健的发展。该刊采用严格的同行评审和编辑流程，确保发表的文章的科学准确性、新颖性和重要性。

原文信息

标题

The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant

作者

Kevin M. Veen¹, Grigorios Papageorgiou², Casper F. Zijderhand¹, Mostafa M. Mokhles¹, Jasper J. Brugts³, Olivier C. Manintveld³, Alina A. Constantinescu³, Jos A. Bekkers¹, Johanna J.M. Takkenberg¹, Ad J.J.C. Bogers¹, Kadir Caliskan³

机构

1. Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA Rotterdam, The Netherlands

2. Department of Biostatistics, Erasmus MC, 3000 CA Rotterdam, The Netherlands

3. Department of Cardiology, Erasmus MC, 3000 CA Rotterdam, The Netherlands

通讯作者

Kadir Caliskan

引用这篇文章

Kevin M. Veen, Grigorios Papageorgiou, Casper F. Zijderhand, Mostafa M. Mokhles, Jasper J. Brugts, Olivier C. Manintveld, Alina A. Constantinescu, Jos A. Bekkers, Johanna J.M. Takkenberg, Ad J.J.C. Bogers, Kadir Caliskan. The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant. Front. Med., 2023, 17(3): 527–533

https://doi.org/10.1007/s11684-022-0967-5

https://journal.hep.com.cn/fmd/EN/10.1007/s11684-022-0967-5

https://link.springer.com/article/10.1007/s11684-022-0967-5

感谢作者对Frontiers of Medicine的信任和支持。

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