Functional Tricuspid Regurgitation and Atrial Fibrillation: Which Comes First, the Chicken or the Egg?

Muraru, Denisa; Caravita, Sergio; Guta, A C; Mihalcea, Diana; Branzi, Giovanna; Parati, Gianfranco; Badano, Luigi P.

doi:10.1016/j.case.2020.04.011

Cited by 22 publications

(21 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ortiz-Leon et al 7 reported RA and tricuspid annulus (TA) dilation in AF patients without severe FTR. Muraru et al 8 documented the direct links among RA remodeling, TA dilation, and development of FTR during AF, leading to the concept that AF may cause FTR by affecting the geometry of the TA through the remodeling of the RA. 9 However, whether a dilated TA in patients with AF is sufficient to cause significant regurgitation is still controversial, as not all patients with AF develop significant FTR.…”

mentioning

confidence: 99%

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

Guta

Badano

Tomaselli

et al. 2021

Journal of the American Society of Echocardiography

Self Cite

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

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

Guta

Badano

Tomaselli

et al. 2021

Journal of the American Society of Echocardiography

Self Cite

View full text Add to dashboard Cite

show abstract

“…TR was graded in four stages: none (0), mild (1), moderate, (2) and severe (3). 13 14 On a 2D RV focused four chamber view RV size and RV function were analysed. Tricuspid annular plane systolic excursion (TAPSE) was calculated on M-mode recordings.…”

Section: Methodsmentioning

confidence: 99%

“…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%

See 1 more Smart Citation

Natural course of tricuspid regurgitation and prognostic implications

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

“…When quantifying the right-chambers' sizes by 2D echocardiography (2DE), signifi cant underestimation may occur due to foreshortening or geometrical assumptions. The 3D-derived methods allow a more accurate and reliable measure of both the RV and the RA, which is one of the key prerequisites in differenti- reports show that cardioversion in atrial FTR with documented maintenance of sinus rhythm promotes TV annulus and RA reverse remodeling and may signifi cantly reduce the severity of FTR at follow-up 26,44,45 .…”

Section: Three-dimensional Echocardiographymentioning

confidence: 99%

Atrial functional tricuspid regurgitation: a novel and underappreciated clinical entity

Florescu

Figliozzi

Guta

et al. 2021

Romanian Journal of Cardiology

Self Cite

View full text Add to dashboard Cite

Functional or secondary tricuspid regurgitation (FTR) is a progressive disease with a significant negative impact on patient morbidity and mortality. Recently, atrial fi brillation (AF) has been recognized as a cause of FTR (with/without coexisting functional mitral regurgitation) by promoting right atrial (RA) remodeling and secondary tricuspid valve (TV) annulus dilation, even in the absence of right ventricular (RV) dilation or dysfunction. This distinct form of FTR has been called “atriogenic” or “atrial”. Recent evidence suggests that the RA is an important player in FTR pathophysiology not only for patients with AF, but also for those in sinus rhythm. Preliminary reports on atrial FTR show that cardioversion with documented maintenance of sinus rhythm promotes TV annulus and RA reverse remodeling and may significantly reduce FTR severity at follow-up. Large-scale studies on the prognostic benefits of rhythm vs rate-control strategy in atrial FTR patients are needed to substantiate specifi c guidelines indications for this subset of patients.

show abstract

Functional Tricuspid Regurgitation and Atrial Fibrillation: Which Comes First, the Chicken or the Egg?

Abstract: Graphical abstract Pathophysiology of “atriogenic” functional tricuspid regurgitation in patients with persistent atrial fibrillation.

Cited by 22 publications

References 15 publications

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

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

Natural course of tricuspid regurgitation and prognostic implications

Atrial functional tricuspid regurgitation: a novel and underappreciated clinical entity

Contact Info

Product

Resources

About