Clinical and echocardiographic factors affecting tricuspid regurgitation severity in the patients with lone atrial fibrillation

초록

Background: Atrial fibrillation (AF) can be a risk factor for development of significant tricuspid regurgitation (TR). We investigated which clinical and echocardiographic parameters were related to severity of functional TR in patients with lone AF. Methods: A total of 89 patients with lone AF were enrolled (75±11 years; 48% male): 13 patients with severe TR, 36 patients with moderate TR, and 40 consecutive patients with less than mild TR. Patients with pacemaker, left ventricular ejection fraction <50%, rheumatic valvular disease, left sided valvular disease, prior valvular surgery, intrinsic tricuspid valvular disease or congenital heart disease were excluded. Clinical parameters and echocardiographic measurements including right ventricular (RV) remodeling and function were evaluated. Results: Patients with more severe TR were older and had more frequently persistent AF (each p<0.001). Also, TR severity was related to left atrial volume, systolic pulmonary artery pressure (SPAP), right atrial area, systolic and diastolic areas of RV, systolic myocardial velocity of the tricuspid valve, RV spherical index, tricuspid annular systolic diameter and tenting height (all p<0.05). Multivariate analysis showed age, type of AF, SPAP and tenting height remained as a significant determinants of severe TR (p=0.043 for age, p=0.002 for type of AF, p=0.017 for SPAP, p<0.001 for tenting height). In addition, tenting height was independently associated with the presence of severe TR (p=0.002). Conclusions: In patients with lone AF, TR was related to age, type of AF, SPAP and RV remodeling. Especially, tricuspid valvular tethering seemed to be independently associated with development of severe functional TR.