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Overview

Juan A. Crestanello, M.D., is a cardiovascular surgeon and department chair of Cardiovascular Surgery at Mayo Clinic in Rochester, Minnesota. Dr. Crestanello, who specializes in surgery for valvular heart disease, discusses the incidence and burden of tricuspid regurgitation in patients with atrial fibrillation.

JUAN A. CRESTANELLO: Welcome to the Cardiovascular Surgery Series, where I discuss the latest research in cardiovascular surgery from the Mayo Clinic. I will discuss, today, incidence and burden of tricuspid regurgitation in patients with atrial fibrillation.

Atrial fibrillation is increasingly recognized as a cause of tricuspid regurgitation. Tricuspid regurgitation associated with atrial fibrillation, in the absence of pulmonary hypertension or left-sided heart disease, is called isolated tricuspid regurgitation. This population-based study was undertaken to understand the impact of atrial fibrillation on the development of tricuspid regurgitation and its impact on the outcomes.

691 patients with recent onset atrial fibrillation and no pulmonary hypertension, no left-sided heart disease, and no TR were identified and followed for 13.3 years. During the course of the study, 33.6% of the patients developed moderate or severe tricuspid regurgitation. A third of the patients had isolated TR, and two-thirds of the patients also developed pulmonary hypertension or left-sided heart disease.

Risk factors for the development of tricuspid regurgitation were older age, female sex, and permanent or persistent atrial fibrillation. On the other hand, rate control therapy was protective from the development of tricuspid regurgitation

The development of moderate or severe TR was associated with an increased risk of death. The incidence of death doubled, after the development of TR, from 2.8 to 6.1 deaths for 100 person per year. The cumulative risk of death after the development of TR was 50% at 10 years. Isolated moderate or severe TR was associated with a 51% greater risk of death in patients with atrial fibrillation.

We conclude that one-third of the patients with atrial fibrillation develop moderate or greater TR over time. Incident, moderate or severe TR of any cause, was associated with more than twofold increased risk of mortality. And incident, isolated moderate or severe TR was associated with a 51% greater risk of death in patients with atrial fibrillation. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.