Influence of tricuspid regurgitation on the prognosis of patients with cardiogenic shock

Tricuspid regurgitation (TR) is associated with adverse prognosis in various patient populations. However, data regarding the prognostic impact in patients with cardiogenic shock (CS) is limited. The study investigates the prognostic impact of pre-existing TR in patients with CS. Consecutive patients with CS from 2019 to 2021 were included in a monocentric registry. Every patient’s medical history, including echocardiographic data, was recorded. The influence of pre-existing TR on prognosis was investigated. Furthermore, Kaplan–Meier analyses based on TR severity were conducted. Statistical analyses comprised univariable t-test, Spearman’s correlation, Kaplan–Meier analyses, as well as multivariable Cox proportional regression models. Analyses were stratified by the underlying cause of CS such as acute myocardial infarction (AMI), or the need for mechanical ventilation. 105 patients with CS and pre-existing TR were included. In Kaplan Meier analyses, it could be demonstrated that patients with severe TR (TR III°) had the highest 30-day all-cause mortality compared to mild (TR I°) and moderate TR (TR II°) (44% vs. 52% vs. 77%; log rank <i>p</i> = .054). In the subgroup analyses of CS-patients without AMI, TR II°/TR III° showed a higher all-cause mortality after 30 days compared to TR I° (39% vs. 64%; log rank <i>p</i> = .027). In multivariable Cox regression TR II°/TR III° was associated with 30-day all-cause mortality in CS-patients without AMI (HR = 2.193; 95% CI 1.007–4.774; <i>p</i> = .048). No significant difference could be found in the AMI group. Furthermore, TR II°/III° was linked to an increased 30-day all-cause mortality in non-ventilated CS-patients (6% vs. 50%, log rank <i>p</i> = .015), which, however, could not be confirmed in multivariable Cox regression. The occurrence of pre-existing TR II°/III° was independently related with 30-day all-cause mortality in CS-patients without AMI. However, no prognostic influence was observed in CS-patients with AMI.

三尖瓣反流（Tricuspid regurgitation, TR）在多种患者群体中均与不良预后相关，但目前关于其对心源性休克（cardiogenic shock, CS）患者的预后影响的相关数据仍较为有限。本研究旨在探讨既往存在的TR对CS患者的预后影响。本研究纳入2019至2021年间连续收治的CS患者，构建单中心注册队列，收集所有患者的病史资料（包括超声心动图检查结果），以此分析既往存在的TR对患者预后的影响，并基于TR严重程度开展Kaplan-Meier生存分析。本研究采用的统计方法包括单因素t检验、Spearman相关分析、Kaplan-Meier生存分析以及多因素Cox比例风险回归模型，并根据CS的潜在病因（如急性心肌梗死（acute myocardial infarction, AMI））及机械通气需求进行分层分析。本研究最终纳入105例合并既往TR的CS患者。Kaplan-Meier生存分析结果显示，与轻度TR（TR I°）、中度TR（TR II°）患者相比，重度TR（TR III°）患者的30天全因死亡率最高，分别为44%、52%与77%（log-rank检验p=0.054）。在无AMI的CS患者亚组中，TR II°/III°患者的30天全因死亡率显著高于TR I°患者（39% vs. 64%；log-rank检验p=0.027）。多因素Cox比例风险回归分析显示，在无AMI的CS患者中，TR II°/III°与30天全因死亡率独立相关（风险比=2.193；95%置信区间：1.007~4.774；p=0.048）；而在AMI亚组中未观察到显著差异。此外，在未接受机械通气的CS患者中，TR II°/III°患者的30天全因死亡率同样显著升高（6% vs. 50%；log-rank检验p=0.015），但该结果未在多因素Cox比例风险回归分析中得到验证。综上，既往存在TR II°/III°与无AMI的CS患者的30天全因死亡率独立相关，但在合并AMI的CS患者中未观察到此类预后影响。