PREVALENCE AND PROGRESSION OF TRICUSPID REGURGITATION IN PATIENTS WITH LONGSTANDING PERSISTENT ATRIAL FIBRILLATION

Abstract

Atrial fibrillation (AF) is a global epidemic, and is associated with progressive tricuspid regurgitation (TR) related to annular dilatation. Data on the prevalence and progression of TR severity are sparse. In this study, we examined the prevalence of TR in patients with longstanding persistent AF, and the natural history of progression of TR on serial echocardiography. In this cohort study, consecutive patients with longstanding persistent AF who underwent serial transthoracic echocardiography (TTE) between 2005 and 2010, and had ≥2 TTEs at least one year apart during the study period, were identified from the echocardiography database of a university-based tertiary care hospital. Patients with previous tricuspid valve surgery or congenital heart disease were excluded. Baseline and the most recent TTEs during the study period were reviewed to assess TR severity and to measure echocardiographic parameters, including right ventricular (RV) and right atrial (RA) dimensions, RV systolic function, and pulmonary artery systolic pressure (PASP). TR severity was assigned a numeric grade of 0 (no TR), 1 (mild), 2 (moderate), 3 (moderate-severe), or 4 (severe). Among the 230 patients (141 male, age at baseline study = 70±11 years) included in the study, 67 (29%) had moderate or greater TR at baseline. During a mean follow-up of 3.3 years, 96 (42%) patients had worsening of TR on follow-up TTEs. The magnitude of increase in TR severity was nearly 1 grade (0.9±0.5). Patients with worsening of TR at follow-up were not significantly different from those whose TR remained similar or decreased in terms of baseline characteristics and echocardiographic parameters. At follow-up, however, patients with worsening of TR had significantly larger RA and RV dimensions, worse RV systolic function, and higher PASP than those whose TR remained similar or decreased over time (Table 1). For patients with longstanding persistent AF, the presence of at least moderate TR is highly prevalent. Nearly half of these patients will progress 1 grade higher in TR severity within three years. Progression of TR is associated with right heart remodelling and worsening of haemodynamics. Future research should examine the clinical impact of TR on the development of heart failure in patients with AF, as well as the treatment and prevention of this highly prevalent condition.