The Pathophysiological Link between Right Atrial Remodeling and Functional Tricuspid Regurgitation in Patients with Atrial Fibrillation: A Three-Dimensional Echocardiography Study

Abstract

Background: Atrial fibrillation (AF) itself may lead to functional tricuspid regurgitation (FTR) through tricuspid annulus (TA) dilation. However, the pathophysiological determinants of TA enlargement in AF patients remain to be clarified. The objectives of this study were (1) to compare the TA size and function in AF patients versus healthy subjects; (2) to identify the determinants of TA remodeling in patients with AF and FTR;and (3) to assess the relationships among right heart structures and severity of FTR in AF patients.Methods: Eighty-three consecutive patients with long-term persistent AF and FTR (61 6 9.9 years, 67% women) were prospectively enrolled and compared with 83 sex and body surface area-matched healthy subjects. Heart chamber size and function and TA geometry were analyzed using three-dimensional echocardiography.Results: Among AF patients, 33%, 34%, and 33% had mild, moderate, and severe FTR, respectively. Right atrial (RA) dilation was detected in 93% of AF patients, while only 27% and 12% of them showed dilated or dysfunctional right ventricle (RV), respectively. End-diastolic TA area had the strongest correlation with the minimum volume of the RA (RAVmin r = 0.6981, P < .0001) but only mild correlation with RV end-diastolic volume and sex (r = 0.3405, P = .0019; r = 0.2914, P = .0075). At multivariable analysis, only RAVmin was independently associated with TA area in AF patients (r = 0.665, P < .0001). The RAVmin and TA area were the only predictors of FTR severity. Conclusions:In patients with AF, RA dilation seems to be more important than RV dilation to determine TA enlargement and subsequent FTR development. The RAVmin and TA area were directly correlated to FTR severity.

Geometrical remodeling of the mitral and tricuspid annuli in response to exercise training: a 3-D echocardiographic study in elite athletes

“…Notably, however, atrial volumes were independent determinants of annular areas, whereas ventricular volumes were not. These results resonate with recent publications showing that the RA dilation is the major determinant of TA size in patients with atrial fibrillation and/or functional TR (20,21). Longitudinal studies with long-term follow-up are required to establish the (patho)physiological link between exercise-induced cardiac remodeling, functional valvular regurgitation, and, eventually, occurrence of atrial fibrillation.…”

Establishment and Validation of a Predictive Model for Long-Term Severe Functional Tricuspid Regurgitation after Mitral Valve Replacement

“…It has been recognized that TA diameter change is an independent FTR contributory factor. Since this study is a retrospective one, it is not considered a routine preoperative measurement parameter, though LATD and LALD can indirectly reflect TA expansion extent [Guta 2021]. In fact, our results demonstrated that no correlation between pre-surgery atrial size in multivariate analysis and long-term S-FTR likelihood is present, which is supported by other researchers, such as David et al [David 2018].…”

Tricuspid annular abnormalities in repaired dextro-transposition of the great arteries following Senning and Mustard procedures (Insights from the CSONGRAD Registry and MAGYAR-Path Study)

“…In dTGA, correlations seem to have disappeared, which could partially explain accompanying tricuspid functional regurgitations. In earlier studies, TA abnormalities were found to be associated with atrial volumes as well, which effects could not be excluded in dTGA patients either (19).…”