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JACC-Cardiovasc. Imag., Available online 11 January 2023| https://doi.org/10.1016/j.jcmg.2022.11.014 Atrial Functional Tricuspid Regurgitation: Importance of Atrial Fibrillation and Right Atrial Remodeling and Prognostic Significance

Soongu Kwak MD^a,b, Jaehyun Lim MD^a,b, Seokhun Yang MD^a,b, Tae-Min Rhee MD^a,b, You-Jung Choi MD, PhD^a,b,c, Hyun-Jung Lee MD^a,b, In-Chang Hwang MD^a,d, Heesun Lee MD^a,e, Yeonyee E. Yoon MD, PhD^a,d, Hyo Eun Park MD, PhD^a,e, Seung-Pyo Lee MD, PhD^a,b, Hyung-Kwan Kim MD, PhD^a,b, Su-Yeon Choi MD, PhD^a,e, Yong-Jin Kim MD, PhD^a,b, Goo-Yeong Cho MD, PhD^a,d, Jun-Bean Park MD, PhD^a,b

^aDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
^bCardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
^cDivision of Cardiology, Department of Internal Medicine, Korea University & Korea University Guro Hospital, Seoul, South Korea
^dDepartment of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
^eHealthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea

Address for correspondence: Dr Jun-Bean Park

Abstract

Background: Little is known about the determinants and outcomes of significant atrial functional tricuspid regurgitation (AFTR).

Objectives: The authors aimed to identify risk factors for significant TR in relation to atrial fibrillation-flutter (AF-AFL) and assess its prognostic implications.

Methods: The authors retrospectively studied patients with mild TR with follow-up echocardiography examinations. Significant TR was defined as greater than or equal to moderate TR. AFTR was defined as TR, attributed to right atrial (RA) remodeling or isolated tricuspid annular dilatation, without other primary or secondary etiology, except for AF-AFL. The Mantel-Byar test was used to compare clinical outcomes by progression of AFTR.

Results: Of 833 patients with mild TR, 291 (34.9%) had AF-AFL. During the median 4.6 years, significant TR developed in 35 patients, including 33 AFTRs. Significant AFTR occurred in patients with AF-AFL more predominantly than in those patients without AF-AFL (10.3% vs 0.6%; P < 0.001). In Cox analysis, AF-AFL was a strong risk factor for AFTR (adjusted HR: 8.33 [95% CI: 2.34-29.69]; P = 0.001). Among patients with AF-AFL, those who developed significant AFTR had larger baseline RA areas (23.8 vs 19.4 cm2; P < 0.001) and RA area-to-right ventricle end-systolic area ratio (3.0 vs 2.3; P < 0.001) than those who did not. These parameters were independent predictors of AFTR progression. The 10-year major adverse cardiovascular event was significantly higher after progression of AFTR than before or without progression (79.8% vs 8.6%; Mantel-Byar P < 0.001).

Conclusions: In patients with mild TR, significant AFTR developed predominantly in patients with AF-AFL, conferring poor prognosis. RA enlargement, especially with increased RA area-to-right ventricle end-systolic area ratio, was a strong risk factor for progression of AFTR.

논문정보

형식Research article
게재일2023년 01월 (BRIC 등록일 2023-01-26)
연구진국내 연구진
분야 의약학 > 응용의학

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