Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease

Takahashi, Yusuke; Izumi, Chisato; Miyake, Makoto; Imanaka, Miyako; Kuroda, Maiko; Nishimura, Shunsuke; Yoshikawa, Yusuke; Amano, Masashi; Imamura, Sari; Onishi, Nobuyuki; Tamaki, Yodo; Enomoto, Soichiro; Tamura, Toshihiro; Kondo, Hirokazu; Kaitani, Kazuaki; Nakagawa, Yoshihisa

doi:10.1016/j.ijcard.2017.05.031

Cited by 28 publications

(17 citation statements)

References 30 publications

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“…Some previous studies reported the favorable short-term prognosis of FTR in patients with AF. For example, Yakahashi et al demonstrated a good prognosis of idiopathic FTR in patients with AF without structural heart disease and no PH with the 1-year cumulative mortality and cumulative mortality due to right-sided heart failure of 5 and 1%, respectively [7]. The present study shows that the cumulative adverse outcomes after 2 years are higher.…”

Section: Importance Of Significant Tricuspid Regurgitation and Pulmonsupporting

confidence: 59%

“…Previous studies have reported a poor prognosis in patients who have AF with heart failure, even with preserved LVEF [1]. This is true as well for patients with AF and persistent TR who required hospitalization for right-sided heart failure [7].…”

Section: Importance Of Significant Tricuspid Regurgitation and Pulmonmentioning

confidence: 85%

“…Abe et al showed that the prevalence of significant FTR increased with the longer duration of AF and was associated with poor prognosis [9]. In contrast, Takahashi et al reported a favorable prognosis of severe isolated TR associated with AF [7]. Therefore, the prognostic significance of FTR in patients with AF remains unsettled.…”

Section: Introductionmentioning

confidence: 99%

“…Moderate to severe functional TR (FTR) is becoming a major concern in patients with AF since it may lead to progressive right ventricular (RV) dilatation and failure, and an increase in morbidity and mortality. The prevalence of significant FTR in patients with AF varies among different studies, ranging from 5 to 35% [ 7 – 10 ]. A large number of previous studies have shown the association between AF and atrial functional mitral regurgitation, and its prognostic value, while only a few studies have focused on significant atrial FTR.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Importance Of Significant Tricuspid Regurgitation and Pulmonsupporting

confidence: 59%

Section: Importance Of Significant Tricuspid Regurgitation and Pulmonmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…The pathogenesis is intricate because of the heterogeneity of etiology, and much research indicates that TR severity is related to pulmonary artery hypertension (PAH) and impaired left ventricular ejection fraction (LVEF) [2, 3]. Moderate to severe TR has usually been reported with a poor prognosis [4]. The most effective treatment of TR is surgery, but little data indicates long-term survival of surgery.…”

Section: Introductionmentioning

confidence: 99%

Analyses for Prevalence and Outcome of Tricuspid Regurgitation in China: An Echocardiography Study of 134,874 Patients

et al. 2019

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Background: The aim of this study is to investigate the prevalence and outcome of tricuspid regurgitation (TR) in the Chinese population. Methods: The echocardiography database, including 134,874 patients at our heart center from 2010 to 2012, was retrospectively analyzed. Results: The rates of mild, moderate, and severe TR were 2.96, 2.22, and 1.39%, respectively. Of these patients, 4.86% had primary TR, 91.41% had functional TR, and 3.73% had unexplained TR. The rate of TR was increased in elders (odds ratio: 1.038 for 1 year’s increment; 95% confidence interval: 1.037–1.040; p < 0.001) and females (odds ratio: 1.386; 95% confidence interval: 1.327–1.448, p < 0.001). The major etiologies of TR were left-sided valve heart disease (VHD) and dilated cardiomyopathy. The survival rate of severe TR patients with pulmonary artery hypertension (PAH) was lower than in those without PAH (p < 0.0001). There was a positive association between the prevalence of TR and impaired left ventricular ejection fraction. Compared to the non-left-sided VHD group, the left-sided VHD group had a better prognosis among severe TR patients. The 5-year survival rates were 79.69, 71.12, and 77.01% in the groups of left-sided VHD, non-left-sided VHD, and all patients. Conclusions: Patients with severe TR have a bad prognosis, especially those with non-left-sided VHD and those with PAH.

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Tricuspid regurgitation in elderly patients with acute heart failure: insights from the KCHF registry

et al. 2023

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Aims Several studies demonstrated that tricuspid regurgitation (TR) is associated with poor clinical outcomes. However, data on patients with TR who experienced acute heart failure (AHF) remains scarce. The purpose of this study is to evaluate the association between TR and clinical outcomes in patients admitted with AHF, using a large‐scale Japanese AHF registry. Methods and results The current study population consisted of 3735 hospitalized patients due to AHF in the Kyoto Congestive Heart Failure (KCHF) registry. TR grades were assessed according to the routine clinical practice at each participating centre. We compared the baseline characteristics and outcomes according to the severity of TR. The primary outcome was all‐cause death. The secondary outcome was hospitalization for heart failure (HF). The median age of the entire study population was 80 (interquartile range: 72–86) years. One thousand two hundred five patients (32.3%) had no TR, while mild, moderate, and severe TR was found in 1537 patients (41.2%), 776 patients (20.8%), and 217 patients (5.8%), respectively. Pulmonary hypertension, significant mitral regurgitation, and atrial fibrillation/flutter were strongly associated with the development of moderate/severe of TR, while left ventricular ejection fraction <50% was inversely associated with it. Among 993 patients with moderate/severe TR, the number of patients who underwent surgical intervention for TR within 1 year was only 13 (1.3%). The median follow‐up duration was 475 (interquartile range: 365–653) days with 94.0% follow‐up at 1 year. As the TR severity increased, the cumulative 1 year incidence of all‐cause death and HF admission proportionally increased ([14.8%, 20.3%, 23.4%, 27.0%] and [18.9%, 23.0%, 28.5%, 28.4%] in no, mild, moderate, and severe TR, respectively). Compared with no TR, the adjusted risks of patients with mild, moderate, and severe TR were significant for all‐cause death (hazard ratio [95% confidence interval]: 1.20 [1.00–1.43], P = 0.0498, 1.32 [1.07–1.62], P = 0.009, and 1.35 [1.00–1.83], P = 0.049, respectively), while those were not significant for hospitalization for HF (hazard ratio [95% confidence interval]: 1.16 [0.97–1.38], P = 0.10, 1.19 [0.96–1.46], P = 0.11, and 1.20 [0.87–1.65], P = 0.27, respectively). The higher adjusted HRs of all the TR grades relative to no TR were significant for all‐cause death in patients aged <80 years, but not in patients aged ≥80 years with significant interaction. Conclusions In a large Japanese AHF population, the grades of TR could successfully stratify the risk of all‐cause death. However, the association of TR with mortality was only modest and attenuated in patients aged 80 or more. Further research is warranted to evaluate how to follow up and manage TR in this elderly population.

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Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease

Cited by 28 publications

References 30 publications

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

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

Analyses for Prevalence and Outcome of Tricuspid Regurgitation in China: An Echocardiography Study of 134,874 Patients

Tricuspid regurgitation in elderly patients with acute heart failure: insights from the KCHF registry

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