Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation

Utsunomiya, Hiroto; Itabashi, Yuji; Mihara, Hirotsugu; Berdejo, Javier; Kobayashi, Shigeto; Siegel, Robert J.; Shiota, Takahiro

doi:10.1161/circimaging.116.004897

Cited by 200 publications

(60 citation statements)

References 25 publications

(26 reference statements)

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“…Although 2D echocardiography is widely used in clinical practice and also for research currently, especially for patients with AF, 2D images lacked from inherent limitations such as incomplete comprehension of 3D tricuspid annulus. 3D echocardiography with one beat acquisition might provide more accurate measurements with more reproducible landmarks and could be used to confirm the present findings in further studies [ 33 , 34 ]. Thirdly, in our subgroup analysis, although propensity-score matching adjusts for baseline imbalances, the analysis does not control for unmeasured confounders.…”

Section: Discussionsupporting

confidence: 78%

Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Wang

et al. 2020

J Cardiothorac Surg

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Background This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation. Methods A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation. Results The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95–97.78) and 92.0% (95% CI: 85.26–95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan–Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047–0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357–09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359–0.981; P = 0.042) in catheter group. Conclusions Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.

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Section: Discussionsupporting

confidence: 78%

Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Wang

et al. 2020

J Cardiothorac Surg

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“…AF leads to atrial enlargement and dilatation of mitral and tricuspid annuli [ 4 ]. Advanced age and right heart enlargement have been associated with atrial FTR [ 8 , 18 , 20 ]. Furthermore, some echocardiographic parameters are related to TR severity in patients with AF, such as LAV index, tricuspid annular diameter, tenting height, right atrial area, PASP and RV remodeling [ 8 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Advanced age and right heart enlargement have been associated with atrial FTR [ 8 , 18 , 20 ]. Furthermore, some echocardiographic parameters are related to TR severity in patients with AF, such as LAV index, tricuspid annular diameter, tenting height, right atrial area, PASP and RV remodeling [ 8 , 25 ]. Apart from the echocardiographic parameters related to right heart remodeling, the present study demonstrated that female gender, LAV index and PH were independently associated with significant FTR in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Significant functional tricuspid regurgitation portends poor outcomes in patients with atrial fibrillation and preserved left ventricular ejection fraction

Prapan

Ratanasit

Karaketklang

2020

BMC Cardiovasc Disord

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Background Significant tricuspid regurgitation (TR) can be found in patients with atrial fibrillation (AF). The results of previous studies are controversial about whether significant functional TR (FTR) in patients with AF leads to worse clinical outcomes. The aims of the study were to investigate the prevalence, predictors and prognosis of significant FTR in patients with AF with preserved left ventricular ejection fraction (LVEF). Methods The present study was a retrospective cohort study in patients with AF and preserved LVEF from May 2013 through January 2018. Significant FTR was defined as moderate to severe TR without structural abnormality of the tricuspid valve. Pulmonary hypertension (PH) was defined as pulmonary artery systolic pressure ≥ 50 mmHg or mean pulmonary artery pressure ≥ 25 mmHg determined by echocardiography. The adverse outcomes were defined as heart failure and death from any cause within 2 years of follow up. Results A total of 300 patients with AF (mean age 68.8 ± 10.8 years, 50% male) were included in the study. Paroxysmal and non-paroxysmal AF were reported in 34.7 and 65.3% of patients, respectively. Mean LVEF was 65.3 ± 6.3%. PH and significant FTR were observed in 31.3 and 21.7% of patients, respectively. Patients with significant FTR were significantly older, more female gender and non-paroxysmal AF, and had higher left atrial volume index and pulmonary artery pressure than those without. A total of 26 (8.7%) patients died and heart failure occurred in 39 (13.0%) patients. There was a statistically significant difference in the adverse outcomes between patients with significant and insignificant FTR (44.6% vs. 11.9%, p < 0.010). Multivariable analysis showed that factors associated with significant FTR were female gender, presence of PH and left atrial volume index (OR = 2.61, 1.87, and 1.04, respectively). The predictors of the adverse outcomes in patients with AF were significant FTR, presence of PH and high CHA2DS2-VASc score (OR = 5.23, 2.23 and 1.60, respectively). Conclusions Significant FTR was common in patients with AF, and independently associated with adverse outcomes. Thus, comprehensive echocardiographic assessment of FTR in patients with AF and preserved LVEF is fundamental in determining the optimal management.

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“…1 2 Besides that, there is evidence that atrial fibrillation (Afib) and right ventricular (RV) pacing may also be of pathophysiological importance. [3][4][5] While significant reflux may be well tolerated for years TR is often neglected. However, literature suggests significant TR is associated with poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Natural course of tricuspid regurgitation and prognostic implications

et al. 2021

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ObjectiveFunctional tricuspid regurgitation (TR) is a frequent finding in echocardiography. Literature suggests significant TR is associated with poor prognosis. Still, data remain limited. This study aimed to evaluate long-term prognostic implications in patients with TR.MethodsIn this observational cohort study, data from 1650 consecutive patients were analysed. Primary endpoint was all-cause mortality. Mean follow-up time was 1090 days. TR grades at baseline and follow-up were compared. Survival analyses were performed to identify prognostic factors.ResultsAt baseline, 14.1% patients showed no, 63.8% mild, 17.4% moderate and 4.7% severe TR. 359 patients (21.8%) died within the study period. TR at baseline was associated with excess mortality. Moderate and severe TR were of prognostic implication in all subgroups irrespective of systolic pulmonary artery pressure (sPAP) (</≥40 mm Hg) and left ventricular ejection fraction (LV-EF) (</≥50%). Survival was worst in patients with moderate and severe TR and concomitant elevated sPAP or reduced LV-EF at 1 and 3 years, respectively (p<0.001; p<0.001). In a multivariate model, including cardiac and non-cardiac risk factors, moderate and severe TR, sPAP and impaired right ventricular (RV) function were independent predictors for survival (HR 1.89, CI 1.07 to 3.36, p=0.029; HR 2.93, CI 1.57 to 5.49, p=0.001; HR 1.44, CI 1.25 to 1.65, p<0.001; HR 1.43, CI 1.14 to 1.79, p=0.002). Overall progression of TR on follow-up was 28.4%. Patients with TR progression showed significantly worse survival (HR 1.44, CI 1.11 to 1.81; p=0.006).ConclusionWhile TR progressed over time, it was associated with impaired long-term survival. TR grade, RV dysfunction, sPAP and TR progression were independent predictors for survival.

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Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation

Cited by 200 publications

References 25 publications

Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Catheter ablation or surgical therapy in moderate-severe tricuspid regurgitation caused by long-standing persistent atrial fibrillation. Propensity score analysis

Significant functional tricuspid regurgitation portends poor outcomes in patients with atrial fibrillation and preserved left ventricular ejection fraction

Natural course of tricuspid regurgitation and prognostic implications

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