Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity

Abstract

Background The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed. Purpose Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus. Methods We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M. Results At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p<0.001 for 2D ED TA diameter; ρ=0.34, p<0.005 for 3D ES RA Vi; ρ=0.33, p<0.005 for 3D ED RV Vi; ρ=0.29, p<0.005 for 3D ES RV Vi). Conclusion Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted. TR Evolution Funding Acknowledgement Type of funding source: None

Refining the Prothrombotic State and Prognosis in Atrial Fibrillation With Left Atrial Appendage 3D Echocardiography

“…28 We demonstrated that management of AF focused on restoration of sinus rhythm could induce anatomical 12 and/or functional cardiac cavity reverse remodeling. 5 The integration of LAA remodeling could be a key future step in understanding the pathophysiological processes involved in AF.…”

“…The FASTRHAC methods have been described previously. 5,18 All consecutive patients (≥18 years) hospitalized for paroxysmal or persistent AF diagnosed on a 12-lead electrocardiogram who provided written informed consent were included. Exclusion criteria were organic valvular disease defined according to the guidelines, [19][20][21] This analysis focuses on the first 218 consecutive patients enrolled in the study who underwent 3D TEE at admission and had a comprehensive follow-up of 2 years (Figure 1).…”

“…3,4 Two-dimensional (2D)/3-dimensional (3D) transthoracic echocardiography (TTE), TEE, cardiovascular magnetic resonance imaging and computed tomography are useful imaging modalities for the volumetric and functional assessment of atrial remodeling. 5 Several cardiac imaging parameters have been described as markers of cardioembolic risk: large LA volumes, 6 left ventricular systolic dysfunction, 7 TEEdetected LA spontaneous echo contrast, 8 decreased LAA emptying and filling velocities, 9 and presence of aortic atheroma. 10 Limited data are available on the association between LAA parameters and LAA prothrombotic state in computed tomography, magnetic resonance imaging [11][12][13] and TEE [14][15][16] (Table S1).…”

Cardiovascular Damage in Patients With a New Coronavirus Infection: Current State of the Problem

“…С повышенным уровнем высокочувствительного сердечного тропонина I (hs-cTnI) в сыворотке (>28 нг/л) связывали повреждение миокарда у 5 из 41 пациента с диагнозом COVID-19 в городе Ухань (Китай) [42]. Проводилась серия исследований учеными медицинской клиники университета Раш, где были обследованы 1 682 пациента с перенеcённой инфекцией COVID-19, 419 из них проводилась эхокардиография [45]. Далее участники исследования были разделены на группы со сниженной фракцией выброса левого желудочка (ФВ ЛЖ <50%), нормальной (≥50% и <70%) и гипердинамической (≥70%).…”

“…Далее участники исследования были разделены на группы со сниженной фракцией выброса левого желудочка (ФВ ЛЖ <50%), нормальной (≥50% и <70%) и гипердинамической (≥70%). Определено, что различий в 60-дневной смертности между пациентами в группах со сниженной и нормальной ФВ ЛЖ (ОШ 0,87, p = 0,68) не было [45].…”