Determinants of Functional Tricuspid Regurgitation in Patients with Lone Atrial Fibrillation

초록

Purpose: Atrial fibrillation (AF) can be a risk factor for development of significant tricuspid regurgitation (TR). We investigated the mechanism of functional TR with structurally normal valve in patients with lone AF. Methods: A total of 73 patients with lone AF were enrolled (74.9±11.2 years; 55% male): 13 patients with severe TR, 26 patients with moderate TR, and 34 consecutive patients with less than mild TR. Patients with pacemaker, left ventricular ejection fraction <50%, rheumatic valvular disease, left sided valvular disease (>mild), prior valvular surgery, intrinsic tricuspid valvular disease or congenital heart disease were excluded. Clinical parameters and echocardiographic measurements including right ventricular (RV) geometry and function were evaluated. Results: Patients with more severe TR were older, more often female, and had more frequently chronic AF (p<0.001 for age, p=0.021 for gender, p<0.001 for type of AF). Also, TR severity was related to left atrial size, right atrial (RA) size, RV end-systolic and enddiastolic area, tricuspid annular diameter, tricuspid valve tenting height, and pulmonary arterial systolic pressure (Table). Multivariate analysis showed TV tenting height remained as a significant determinant of severe TR in chronic AF (p=0.03). Tethering height was influenced by the RA and RV size and RV spherical index (p<0.001). Conclusion: Tenting height, which linked to RA & RV enlargement as well as RV spherical deformation, was independently associated with TR severity in the patients with lone AF. Valvular tethering can be a predominant mechanism for developing severe TR in this population. Table. Comparison of Echocardiographic Parameters in Patients with AF According to TR Severity