Gonzalez-Gomez et al reported the 4A classification for a patient with tricuspid regurgitation. This can help to identify a patient who may benefit from more aggressive management. The authors are from Hospital Universitario Ramon y Cajal, CIBERCV, and CNIC in Madrid, Spain.
Patient selection: tricuspid regurgitation
Outcome: hospital admission for right heart failure or cardiovascular death
The 4 A's:
(1) asthenia
(2) ankle swelling
(3) abdominal pain or distention
(4) anorexia
Response
Points
absent
0
present
1
total score =
= SUM(points for all of the items)
Interpretation:
• minimum score: 0
• maximum score: 4
Total Score
4A Designation
Event-Free Survival at 24 Months
0
A0
76%
1
A1
67%
2
A2
32%
3 or 4
A3
18%
Performance:
• The c-statistic is 0.63.
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