Tricuspid and mitral remodelling in atrial fibrillation: a three-dimensional echocardiographic study

Abstract

Aims Atrial fibrillation (AF) is associated with atrial enlargement, mitral annulus (MA) and tricuspid annulus (TA) dilation, and atrial functional regurgitation (AFR). However, less is known about the impact of AF on both atrioventricular valves in those with normal and abnormal ventricular function. We aimed to compare the remodelling of the TA and MA in patients with non-valvular AF without significant AFR. Methods and results Ninety-two patients referred for transoesophageal echocardiography were included and categorized into three groups: (i) AF with normal left ventricular (LV) function (Normal LV-AF), n = 36; (ii) AF with LV systolic dysfunction (LVSD-AF), n = 29; and (iii) Controls in sinus rhythm, n = 27. Three-dimensional MA and TA geometry were analysed using automated software. In patients with AF regardless of LV function, the MA and TA areas were larger compared with controls (LVSD-AF vs. Normal LV-AF vs. Controls, end-systolic MA: 5.2 ± 1.1 vs. 4.5 ± 0.7 vs. 3.9 ± 0.7 cm2/m2; end-systolic TA: 5.6 ± 1.3 vs. 5.3 ± 1.3 vs. 4.1 ± 0.7 cm2/m2; P < 0.05 for each comparison with Controls). TA and MA areas were not statistically different between the two AF groups. The TA increase over controls was greater than that of the MA in the Normal LV-AF group (27.7% vs. 15.6%, P = 0.041). Conversely, in the LVSD-AF group, MA and TA increased similarly (35.9% vs. 32.4%, P = 0.660). Conclusion Patients with AF showed dilation of both TA and MA compared with patients in sinus rhythm. In patients with normal LV function, AF was associated with greater TA dilation than MA dilation whereas in patients with LVSD the TA and MA were equally dilated.

Assessing emerging causes of mitral regurgitation: atrial functional mitral regurgitation

“… 94 Tricuspid regurgitation (TR) caused by enlargement of the tricuspid annulus often occurs with coexistent MR and AF. 95 According to the Japanese guidelines for AF and MR published in 2020, surgical repair of the tricuspid valve should be considered for patients with combined AF and MR with TR, although the specific criteria for tricuspid valve intervention with regards to annular size, severity of TR and right ventricular function remain unclear (Class IIa recommendation). 80 …”

“…However, one study of patients who underwent mitral valve surgery for MR and/or mitral stenosis along with tricuspid valve repair for mild-to-moderate TR found that failure to address AF during surgery was linked to a greater risk of a composite endpoint that included tricuspid valve reoperation, heart failure and death. 95 – 97 Some small series have shown a reduction in MR severity and symptoms after receiving mitral valve surgery. 96 – 101 …”

Mecanismos Fisiopatológicos, Avaliação Clínica E Estratégias De Manejo Da Regurgitação Tricúspide

“…Em pacientes com função ventricular esquerda normal, a FA pode resultar em maior dilatação do anel tricúspide do que a dilatação do anel mitral 16 . Pacientes com insuficiência cardíaca e fração de ejeção preservada, com ou sem fibrilação atrial, também apresentam alta prevalência de regurgitação tricúspide de importância prognóstica, resultante da dilatação do anel e do átrio direito 17,18 .…”

Can rhythm therapy cure valvular disease?

“…There is a bidirectional connection between AF and VHD, in which the causal relationship cannot always be determined. AF is particularly associated with functional tricuspid regurgitation (TR), leaving the structure of the leaflets and chordae normal, whereas regurgitation is primarily caused by changes of the surrounding structures—annular dilatation and dysfunction of the right ventricle [ 2 ]. Higher grade TR, although often clinically silent for a long time, can cause severe problems of right heart failure, congestion, and also mortality.…”