Mechanistic Insights Into Significant Atrial Functional Tricuspid Regurgitation

Matta, Milad; Layoun, Habib; Hassan, Ossama K. Abou; Rodríguez, Leonardo; Schoenhagen, Paul; Kanj, Mohamed; Griffin, Brian P.; Kapadia, Samir; Harb, Serge C.

doi:10.1016/j.jcmg.2021.05.025

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Larger RA volumes associate with TR in patients with AF. 22 However, RA enlargement 35 was evident in the study cohorts in the present analysis and larger RA areas were noted in patients undergoing TTVR relative to conservative treatment.…”

Section: Discussionmentioning

confidence: 48%

“…This finding may be considered a limitation of our definition, however, the longer standing presence of pulmonary hypertension frequently is reflected by altered RV geometry with RV dilatation, a parameter that was part of our atrial TR definition. In addition, in a prior analysis on atrial TR, in patients with AF, those with significant atrial TR had higher sPAP compared with those without significant TR, 22 suggesting that elevated sPAP may not preclude classification as atrial TR. However, in this analysis, also patients with nonprimary MR of greater or equal to grade 2 were able to get classified as atrial TR, which may be considered a limitation of that atrial TR definition.…”

Section: Discussionmentioning

confidence: 94%

“…However, in this analysis, also patients with nonprimary MR of greater or equal to grade 2 were able to get classified as atrial TR, which may be considered a limitation of that atrial TR definition. 22 Patients with MR >grade 2 were excluded in our analysis, as these patients would have likely received combined transcatheter mitral and tricuspid valve repair in the interventional cohort. The association of atrial TR with AF is conflictingly discussed.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13][14] First described in 2002, 15 definitions of atrial TR vary, however, most commonly a stepwise exclusion of clinical or echocardiographic parameters is used to identify atrial/ isolated TR. 1,[16][17][18][19][20][21][22] Atrial TR, isolated TR and TR in heart failure with preserved ejection fraction appear to reflect similar entities despite minor variations. 1,6,16,17,22 A common feature, however, appears to be the absence of either ventricular (systolic) dysfunction or leaflet tethering.…”

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confidence: 99%

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Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis

Schlotter

Dietz

Stolz

et al. 2022

Circ: Cardiovascular Interventions

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Background: Atrial functional tricuspid regurgitation (atrial TR) has received growing recognition as a TR entity with a distinct cause owing to its independence from valvular tethering as the predominant mechanism underlying TR. However, characterization of atrial TR varies, and a universal definition is lacking. Methods: In total, 651 patients with significant functional TR were analyzed, including 438 conservatively treated individuals and 213 patients who received transcatheter tricuspid valve repair (TTVR). Based on a clustering approach, we defined atrial TR as tricuspid valve (TV) tenting height ≤10 mm, midventricular right ventricular diameter ≤38 mm, and left ventricular ejection fraction ≥50%. Results: Patients with atrial TR were more often females, had higher right ventricular fractional area change, higher left ventricular ejection fraction, and lower LV end-diastolic diameter, TV tenting area and height, lower right ventricular and tricuspid annular size, enlarged, but lower right atrial area and lower TV effective regurgitant orifice area (all P <0.05). Patients with atrial TR had significantly better long-term survival than non-atrial TR in the conservatively treated TR cohort ( P <0.01, n=438). Atrial TR was independently associated with a lower rate of the combined end point of mortality and heart failure hospitalization at 1-year follow-up in the TTVR cohort (hazard ratio, 0.39; P <0.05, n=213). TR degree was significantly reduced after TTVR in non-atrial and atrial TR ( P <0.01). Functional parameters significantly improved following TTVR independent of TR cause ( P <0.05). Conclusions: An echocardiography-based atrial TR definition is associated with prognostic relevance in patients with functional TR in conservatively treated TR and after TTVR.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis

Schlotter

Dietz

Stolz

et al. 2022

Circ: Cardiovascular Interventions

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“…Significant AF-TR is associated with higher grades of right atrial dysfunction and lower values of right atrial strain, reinforcing the concept that AF-TR is mainly a disease of RA and tricuspid annulus [ 18 ].…”

Section: Introductionmentioning

confidence: 74%

Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients

Vijan

Daha

Delcea

et al. 2022

JCM

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Background and Aim: Atrial fibrillation (AF) is an epidemic disease with a significant global health impact. Atrial functional tricuspid regurgitation (AF-TR) is a more recently acknowledged complication of AF. The main purpose of this study was to determine the prognostic value of severe AF-TR in patients with AF, and its determinants. Methods: In this retrospective, observational study, we included AF patients admitted consecutively to a tertiary clinical hospital between January 2018 and February 2020, irrespective of cause of hospitalization. Patients with organic TR, significant pulmonary hypertension, left ventricular ejection fraction < 50%, those with implanted cardiac devices and those with in-hospital mortality were excluded. Severe TR was defined according to current guidelines. Median follow-up time was 34 (28–39) months. Primary endpoint was all-cause mortality. Results: We included 246 AF patients, with a mean age of 71.5 ± 9.4 years. 86.2% had AF-TR, while 8.1% had severe AF-TR. Mortality rate was 8.5%. Right atrial diameter (p = 0.005), systolic pulmonary artery pressure (sPAP) (p = 0.015) and NT-proBNP (p = 0.026) were independent predictors for the presence of severe valvular dysfunction. In multivariable survival analysis, severe AF-TR, was an independent predictor of all-cause mortality (HR 5.4, 95% CI 1.1–26.2, p = 0.035). Conclusion: Severe AF-TR was an independent predictor of mortality in AF patients, while mild/moderate AF-TR apparently had no impact on prognosis.

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Atrial Functional Tricuspid Regurgitation

Wang

Akintoye

2023

JACC: Cardiovascular Imaging

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Mechanistic Insights Into Significant Atrial Functional Tricuspid Regurgitation

Cited by 8 publications

References 5 publications

Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis

Atrial Functional Tricuspid Regurgitation: Novel Definition and Impact on Prognosis

Prognostic Impact of Severe Atrial Functional Tricuspid Regurgitation in Atrial Fibrillation Patients

Atrial Functional Tricuspid Regurgitation

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