The 4A classification for patients with tricuspid regurgitation

Area of Science:

• Cardiology
• Clinical Medicine
• Medical Diagnostics

Background:

• Significant tricuspid regurgitation (TR) is linked to increased patient morbidity and mortality.
• Clinical assessment of TR patients presents significant challenges.
• Existing evaluation methods may not fully capture prognostic indicators.

Purpose of the Study:

• To introduce and validate the 4A classification, a novel clinical tool for TR patients.
• To assess the prognostic performance of the 4A classification in predicting adverse cardiovascular events.

Main Methods:

• Inclusion of 135 patients with severe isolated TR and no prior heart failure (HF).
• Assessment of asthenia, ankle swelling, abdominal pain/distention, and anorexia (the 4 As).
• Classification from A0 (no symptoms) to A3 (3-4 symptoms); combined endpoint of HF hospitalization or cardiovascular death.

Main Results:

• During a median 26-month follow-up, 39% of patients experienced the combined endpoint (34% HF hospitalization, 5% cardiovascular death).
• Patients with 4A classes A2 or A3 at baseline showed a high incidence of events.
• The 4A classification change independently predicted HF and cardiovascular mortality (aHR per unit change: 1.95).

Conclusions:

• The 4A classification is a novel, clinically derived tool for patients with significant TR.
• This classification demonstrates prognostic value for predicting adverse events, including heart failure and cardiovascular mortality.
• The 4A classification provides a simple yet effective method for risk stratification in TR.