Outcome of patients with severe secondary tricuspid regurgitation treated first with diuretics - 25/12/18
Résumé |
Background |
Medical treatment based on diuretics was often attempted in patients with severe secondary tricuspid regurgitation even when risk of surgery was acceptable. This strategy tends currently to be abandoned.
Purpose |
Estimate the rate of heart failure hospitalization and cardiac mortality of patients with severe secondary tricuspid regurgitation treated first with diuretics.
Methods |
The study is retrospective and observational. We included patients with severe secondary tricuspid regurgitation, defined as PISA radius superior to 9mm at a Nyquist limit of 28cm/s. Tricuspid regurgitation was assessed by echocardiography before and after treatment with furosemide. Reduction in tricuspid regurgitation was defined by a decrease in PISA radius superior to 50%. The primary end point was heart failure hospitalization or cardiac mortality.
Results |
Three hundred and fourteen patients were included, with a mean age of 69.2±13.7 years and 53.2% of men. The mean left ventricular ejection fraction was 41.3±11.8%. Sixty three percent of the patients had a history of left side surgery. Right ventricular dysfunction assessed by echocardiography was present in 69.4% of cases. The median started dose of furosemide was 236±129mg. After a median follow up of 90 days, improvement of the tricuspid regurgitation was observed in 18.5% (n=58) of the patients. Eighty three (26.4%) patients died. More than half of the patients were hospitalized for heart failure (63.4%; n=199). Occurrence of events was associated with TAPSE (P=0.04), S wave on DTI (P=0.03), pulmonary systolic pressure (P=0.02), left ventricular ejection fraction (P=0.02), but not with decrease in tricuspid regurgitation severity.
Conclusion |
Data from our study show that medical treatment with diuretics should not delay cardiac surgery in patients with severe secondary tricuspid regurgitation.
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Vol 11 - N° 1
P. 75 - janvier 2019 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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