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The 4A classification for patients with tricuspid regurgitation. | LitMetric

AI Article Synopsis

  • This study introduces a new classification system called the 4A classification for evaluating patients with significant tricuspid regurgitation (TR) to help predict their health outcomes.
  • Researchers analyzed 135 patients with severe TR over a median follow-up of 26 months, finding that 39% experienced serious health events, including hospital admissions and deaths.
  • The presence of symptoms classified as A2 or A3 indicated a higher risk of these events, and changes in 4A class were associated with an increased risk of heart failure and cardiovascular mortality.

Article Abstract

Introduction And Objectives: Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Clinical evaluation of TR patients is challenging. Our aim was to establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its prognostic performance.

Methods: We included patients with isolated TR that was at least severe and without previous episodes of heart failure (HF) who were assessed in the heart valve clinic. We registered signs and symptoms of asthenia, ankle swelling, abdominal pain or distention and/or anorexia and followed up the patients every 6 months. The 4A classification ranged from A0 (no A) to A3 (3 or 4 As present). We defined a combined endpoint consisting of hospital admission due to right HF or cardiovascular mortality.

Results: We included 135 patients with significant TR between 2016 and 2021 (69% females, mean age 78±7 years). During a median follow-up of 26 [IQR, 10-41] months, 39% (n=53) patients had the combined endpoint: 34% (n=46) were admitted for HF and 5% (n=7) died. At baseline, 94% of the patients were in NYHA I or II, while 24% were in classes A2 or A3. The presence of A2 or A3 conferred a high incidence of events. The change in 4A class remained an independent marker of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class, 1.95 [1.37-2.77]; P<.001).

Conclusions: This study reports a novel clinical classification specifically for patients with TR that is based on signs and symptoms of right HF and has prognostic value for events.

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Source
http://dx.doi.org/10.1016/j.rec.2023.02.008DOI Listing

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