Prevalence and prognosis of severe tricuspid regurgitation in patients with atrial fibrillation with normal left ventricular systolic function

Abstract

Abstract Background Significant functional tricuspid regurgitation (FTR) can be found in some patients with atrial fibrillation (AF). The results of the previous studies are still controversial whether significant FTR in patients with AF can cause worse outcomes such as heart failure or death. Purpose To study the prevalence, predictors and prognosis of significant FTR in patients with AF with normal left ventricular (LV) systolic function. Methods We conducted a retrospective cohort study in patients with AF and normal LV ejection fraction (LVEF) from May 2013 through January 2018. Significant FTR was defined as moderate to severe FTR. Pulmonary hypertension (PH) was defined as right ventricular systolic pressure >50 mmHg or mean pulmonary artery pressure >25 mmHg. We evaluated the prevalence of significant FTR and evaluated the adverse outcomes between significant and insignificant FTR groups. The adverse outcomes were defined as heart failure visit or hospitalization and all cause death within 2 years of follow up. We also evaluated the factors associated with significant FTR in AF patients. Results There were 498 patients with AF and 300 (mean age 68.8±10.8 years, 50% female) were included in the study. Paroxysmal, persistent and permanent AF were found in 34.7%, 44.7% and 20.6% respectively. Mean LVEF was 65.3±6.3%. PH and significant FTR were reported in 30.7% and 21.7%, respectively. All cause death and heart failure (visit and hospitalization) were found in 26 (8.7%) and 39 (13%) patients, respectively. There was no statistically significant difference in death between patients with significant and insignificant FTR (12.3% vs. 7.7%; 95% confidence interval (CI) 0.70–4.08, p=0.24). Patients with significant FTR had heart failure more often than those with insignificant FTR (61.5% vs. 38.5%; 95% CI 4.15 - 17.75, OR 8.58, p<0.001). The multivariate analysis showed that the predictors of significant FTR were female gender, permanent AF and presence of PH (OR 2.5, 3.6 and 6.1, respectively). The predictors of the adverse outcomes in patients with AF were high CHA2DS2-VASc score (95% CI 1.09 - 1.92, p=0.01) and significant FTR (95% CI 9.61 - 698.17, p<0.01). Conclusions Significant FTR was common in patients with AF and associated with heart failure outcomes. Female gender, permanent AF and presence of PH were independent predictors of significant FTR, while high CHA2DS2-VASc score and significant FTR were independent predictors of the adverse outcomes in patients with AF and normal LVEF. Funding Acknowledgement Type of funding source: None