Abstract
Background
Growing evidence shows a major outcome impact and undertreatment of tricuspid regurgitation
(TR), but large and comprehensive contemporary reports of management and outcome at
the nationwide level are lacking.
Methods
We gathered all consecutive patients admitted with a diagnosis of likely functional
TR in 2014-2015 in France from the Programme de Médicalisation des Systèmes d’Information
national database and collected rate of surgery, in-hospital mortality, 1-year mortality,
or heart failure (HF) readmission rates.
Results
In 2014-2015, 17,676 consecutive patients (75 ± 14 years of age, 51% female) were
admitted with a TR diagnosis. Charlson index was ≥ 2 in 56% of the population and
46% presented with HF. TR was associated with prior cardiac surgery, ischemic/dilated
cardiomyopathy, or mitral regurgitation in 73% of patients. Only 10% of TR patients
overall and 67% of those undergoing mitral valve surgery received a tricuspid valve
intervention. Among the 13,654 (77%) conservatively managed patients, in-hospital
mortality, 1-year mortality, and 1-year mortality or HF readmission rates were 5.1%,
17.8%, and 41%, respectively, overall, and 5.3%,17.2%, and 37%, respectively, among
those with no underlying medical conditions (8-fold higher than predicted for age
and gender).
Conclusions
This nationwide cohort of patients admitted with TR included elderly patients with
frequent comorbidities/underlying cardiac diseases. In patients conservatively managed,
mortality and morbidity were considerably high over a short time span. Despite this
poor prognosis, only 10% of patients underwent a tricuspid valve intervention. These
nationwide data showing a considerable risk and potential underuse of treatment highlight
the critical need to develop strategies to improve the management and outcomes of
TR patients.
Résumé
Contexte
De plus en plus de données montrent que l’insuffisance tricuspide (IT) influence le
pronostic et est fréquemment sous-traitée. Toutefois, des données issues de larges
registres nationaux évaluant la prise en charge et le devenir des patients présentant
une IT sont rares.
Méthodologie
Nous avons extrait de la base de données nationale du Programme de médicalisation
des systèmes d’information (France) les renseignements relatifs aux patients consécutifs
admis en 2014-2015 dans un hôpital français en raison d’un diagnostic de IT vraisemblablement
fonctionnelle, afin d’examiner les taux d’intervention chirurgicale, de mortalité
hospitalière, de mortalité à 1 an et de réadmission pour insuffisance cardiaque.
Résultats
En 2014-2015, 17 676 patients consécutifs (75 ± 14 ans, 51 % de femmes) ont été hospitalisés
avec un diagnostic d’IT ; 56 % présentaient un indice de Charlson ≥ 2 et 46 % une
insuffisance cardiaque. L’IT était associée à un antécédent de chirurgie cardiaque,
une cardiomyopathie dilatée ou ischémique ou à une insuffisance mitrale dans 73 %
des cas. Dans l’ensemble de la population, seuls 10 % des patients présentant une
IT ont été opérés sur la valve tricuspide et seulement 67 % de ceux opérés sur la
valve mitrale ont bénéficié d’une chirurgie concomitante sur la valve tricuspide.
Parmi les 13 654 patients pris en charge médicalement, le taux de mortalité hospitalière,
de mortalité à 1 an et de mortalité à un an ou de réadmission pour insuffisance cardiaque
étaient respectivement de 5,1 %, 17,8 % et 41 % dans l’ensemble de la population et
5,3 %, 17,2 % et 37 % chez ceux présentant une IT en l’absence de pathologie associée
(taux huit fois plus élevés que ceux attendu dans une population de même âge et sexe).
Conclusions
Dans cette large cohorte française regroupant tous les patients admis pour une IT
en 2014-2015, la majorité des patients était âgés avec de fréquentes comorbidités.
La mortalité et morbidité à court terme des patients pris en charge médicalement était
considérable. Malgré ce sombre pronostic, seuls 10 % des patients ont bénéficié d’une
chirurgie tricuspide. Ces données, montrent à l’échelle nationale, l’insuffisance
de traitement et risque considérable encouru par les patients présentant une IT et
la nécessité de développer de nouvelles approches pour améliorer leur prise en charge
et leur devenir.
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Article info
Publication history
Published online: December 20, 2020
Accepted:
December 15,
2020
Received:
November 9,
2020
Footnotes
See editorial by Ong and Connelly, pages 943–944 of this issue.
See page 1083 for disclosure information.
Identification
Copyright
© 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- No Longer the “Forgotten Valve”? Tricuspid Regurgitation Management and Outcomes: Narrowing the Knowledge Gap One Step at a TimeCanadian Journal of CardiologyVol. 37Issue 7
