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Impact of concomitant tricuspid regurgitation on long-term outcomes in severe aortic stenosis.

Authors
  • Amano, Masashi1
  • Izumi, Chisato1
  • Taniguchi, Tomohiko2
  • Morimoto, Takeshi3
  • Miyake, Makoto1
  • Nishimura, Shunsuke1
  • Kitai, Takeshi4
  • Kato, Takao2
  • Kadota, Kazushige5
  • Ando, Kenji6
  • Furukawa, Yutaka4
  • Inada, Tsukasa7
  • Inoko, Moriaki8
  • Ishii, Katsuhisa9
  • Sakaguchi, Genichi10
  • Yamazaki, Fumio11
  • Koyama, Tadaaki12
  • Komiya, Tatsuhiko13
  • Yamanaka, Kazuo14
  • Nishiwaki, Noboru15
  • And 16 more
  • 1 Department of Cardiology, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, Japan. , (Japan)
  • 2 Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. , (Japan)
  • 3 Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan. , (Japan)
  • 4 Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan. , (Japan)
  • 5 Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan. , (Japan)
  • 6 Department of Cardiology, Kokura Memorial Hospital, Kitakyusyu, Japan. , (Japan)
  • 7 Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan. , (Japan)
  • 8 Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan. , (Japan)
  • 9 Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan. , (Japan)
  • 10 Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan. , (Japan)
  • 11 Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. , (Japan)
  • 12 Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. , (Japan)
  • 13 Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan. , (Japan)
  • 14 Department of Cardiovascular Surgery, Tenri Hospital, Tenri, Japan. , (Japan)
  • 15 Department of Cardiovascular Surgery, Kindai University Nara Hospital, Ikoma, Japan. , (Japan)
  • 16 Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan. , (Japan)
  • 17 Department of Cardiovascular Surgery, Kindai University Hospital, Osakasayama, Japan. , (Japan)
  • 18 Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan. , (Japan)
  • 19 Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan. , (Japan)
  • 20 Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan. , (Japan)
  • 21 Department of Cardiovascular Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan. , (Japan)
  • 22 Department of Cardiovascular Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. , (Japan)
  • 23 Department of Cardiovascular Surgery, Cardiovascular Center, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan. , (Japan)
  • 24 Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. , (Japan)
  • 25 Department of Cardiovascular Surgery, Rakuwakai Otowa Hospital, Kyoto, Japan. , (Japan)
  • 26 Department of Cardiovascular Surgery, Shiga Medical Center for Adults, Moriyama, Japan. , (Japan)
  • 27 Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu, Japan. , (Japan)
  • 28 Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan. , (Japan)
  • 29 Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. , (Japan)
Type
Published Article
Journal
European Heart Journal - Cardiovascular Imaging
Publisher
Oxford University Press
Publication Date
Mar 01, 2019
Volume
20
Issue
3
Pages
353–360
Identifiers
DOI: 10.1093/ehjci/jey105
PMID: 30085068
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Tricuspid regurgitation (TR) has been reported to be associated with worse survival in various heart diseases, but there are few data in aortic stenosis (AS). In the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) Registry enrolling 3815 consecutive patients with severe AS, there were 628 patients with moderate or severe TR (TR group) and 3187 patients with no or mild TR (no TR group). The study patients were subdivided into the initial aortic valve replacement (AVR) stratum (n = 1197) and the conservative stratum (n = 2618) according to treatment strategy. The primary outcome measure was a composite of aortic valve-related death or hospitalization due to heart failure. The 5-year freedom rate from the primary outcome measure was significantly lower in the TR group than in the no TR group (49.1% vs. 67.3%, P < 0.001). Even after adjusting for confounders, the excess risk of TR relative to no TR for the primary outcome measure remained significant [hazard ratio (HR): 1.25, 95% confidence interval (CI): 1.06-1.48; P = 0.008]. The trend for the excess adjusted risk in the TR group was consistent in the initial AVR and the conservative strata (HR 1.55, 95% CI: 0.97-2.48; P = 0.07; HR 1.22, 95% CI: 1.02-1.46; P = 0.03, respectively). In the initial AVR stratum, the 5-year freedom rate from the primary outcome measure was not different between the two groups with (n = 56) or without (n = 91) concomitant tricuspid annuloplasty (61.5% vs. 72.1%, P = 0.48). The presence of clinically significant TR concomitant with severe AS is associated with a poor long-term outcome, regardless of the initial treatment strategy. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: [email protected]

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