Effect of Tricuspid Regurgitation on the Reported Quality of Life and Subsequent Outcomes in Patients With Atrial Fibrillation

Abstract

Background Atrial fibrillation and heart failure (HF) possess mutual risk factors and share a common pathophysiological pathway. Tricuspid regurgitation (TR) is a known predictor of adverse events in patients with HF. However, its implications on patients with atrial fibrillation in its early stage remain unknown. Methods and Results Data of 2211 patients without previous HF diagnosis were extracted from a prospective, multicenter registry of newly diagnosed patients with atrial fibrillation. TR was categorized as absent, mild, moderate, and severe based on the American Society of Echocardiography recommendations. The primary outcome was time to first hospitalization for HF after enrollment. The Atrial Fibrillation Effects on Quality‐of‐Life scores were compared. Overall, 1107 patients (50.1%) had TR (42.3%, 7.2%, and 0.6% for mild, moderate, and severe, respectively). During follow‐up (median 730 [interquartile range, 366–731] days), 44 patients (2.0%) experienced HF hospitalization, and the incidence increased with severity of TR ( P <0.001). TR was an associated predictor of the primary outcome (hazard ratio [HR]: 2.51, P =0.050; HR: 6.19, P =0.008; for moderate and severe TR versus no TR). Changes in AFEQT overall score were negatively related to TR severity (8.7±17.5 versus 8.5±17.0 versus 3.1±17.5 versus 1.4±11.8, absent versus mild versus moderate versus severe TR, respectively), although it was not an independent predictor after adjustments. Conclusions TR severity at atrial fibrillation diagnosis was an associated predictor of subsequent hospitalization for HF, which may warrant the need for a more intensive follow‐up and HF‐related management.

Most hospitalized patients with significant tricuspid regurgitation have advanced disease preventing transcatheter tricuspid valve intervention

“…More than moderate tricuspid regurgitation (TR) is associated with high operative mortality. [1][2][3][4][5][6][7][8] Due to significant operative risk, surgical TVR is uncommonly performed due in part to late clinical presentation. [9][10][11][12] Several new transcatheter tricuspid valve intervention (TTVI) devices are being developed as a lower-risk alternative to surgery.…”

Most Hospitalized Patients with Significant Tricuspid Regurgitation Have Advanced Disease Preventing Transcatheter Tricuspid Valve Intervention

“…More than moderate tricuspid regurgitation (TR) is associated with high operative mortality. [1][2][3][4][5][6][7][8] Due to significant operative risk, surgical TVR is uncommonly performed due in part to late clinical presentation. [9][10][11][12] Several new transcatheter tricuspid valve intervention (TTVI) devices are being developed as a lower-risk alternative to surgery.…”

Which lesions are not amenable to tricuspid clipping?

“…Severe tricuspid regurgitation is independently associated with mortality [1,2], heart failure, and poor quality of life [3]. Although diuretics remain the cornerstone of medical management of severe tricuspid regurgitation [4], tricuspid transcatheter edge-toedge repair (T-TEER) has emerged as a promising alternative; given the high mortality associated with isolated tricuspid surgery [5].…”