Atrial functional tricuspid regurgitation: a novel and underappreciated clinical entity

Abstract

Functional or secondary tricuspid regurgitation (FTR) is a progressive disease with a significant negative impact on patient morbidity and mortality. Recently, atrial fi brillation (AF) has been recognized as a cause of FTR (with/without coexisting functional mitral regurgitation) by promoting right atrial (RA) remodeling and secondary tricuspid valve (TV) annulus dilation, even in the absence of right ventricular (RV) dilation or dysfunction. This distinct form of FTR has been called “atriogenic” or “atrial”. Recent evidence suggests that the RA is an important player in FTR pathophysiology not only for patients with AF, but also for those in sinus rhythm. Preliminary reports on atrial FTR show that cardioversion with documented maintenance of sinus rhythm promotes TV annulus and RA reverse remodeling and may significantly reduce FTR severity at follow-up. Large-scale studies on the prognostic benefits of rhythm vs rate-control strategy in atrial FTR patients are needed to substantiate specifi c guidelines indications for this subset of patients.

Different Causes of Functional Tricuspid Valve Regurgitation Are Linked to Differences in Tricuspid Valve and Right-Sided Heart Geometry and Function: 3D Echocardiography Study

“…Until now, most research has been focused on the differences of right heart geometry between atrial functional (AF-TR) and ventricular functional TR (VF-TR) [ 1 , 22 , 23 , 24 ]. Topilsky et al analyzed a total of 281 cases with isolated TR (AF-TR) and pulmonary hypertension-related fTR (VF-TR) and reported characteristic TV geometry and RV remodeling [ 6 ].…”