Cardiovascular Diseases and Cardiac Surgery

Sept. 27, 2023

Atrial fibrillation (AF) is considered a risk factor for isolated tricuspid valve regurgitation (TR) in the absence of other known etiologies. A Mayo Clinic study published in the December 2022 issue of the Journal of the American College of Cardiology, sought to identify the incidence of clinically significant isolated TR and its impact in patients with AF.

A population-based record linkage system was used to identify adult patients with new-onset AF. Patients were excluded if there was evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery, or impaired left ventricular systolic or diastolic function at baseline. The remaining patients were followed over time to identify development of moderate or greater TR and assess its impact on survival.

A total of 232 patients (33.6%) developed moderate or greater TR. Among these, 73 patients (10.6%) had isolated TR without significant underlying structural heart disease. Incidence of any moderate or greater TR was 3.9 cases and that of isolated TR was 1.3 cases per 100 person-years. Permanent or persistent AF and female sex were associated with increased risk of developing TR, whereas rhythm control was associated with lower risk of TR. Over a median clinical follow-up of 13.3 years (interquartile range: 10.0 to 15.9 years); development of any moderate or greater TR (hazard ratio (HR): 2.92; 95% confidence interval (95% CI): 2.29 to 3.73; P < 0.001); and isolated significant TR (HR: 1.51; 95% CI: 1.03 to 2.22; P = 0.03) were associated with an adjusted increased risk of subsequent mortality.

In this population-based cohort of patients with AF, nearly one-third developed moderate or greater TR over time. Incident-significant TR and incident-isolated significant TR portend a worse survival in patients with AF.

For more information

Patlolla SR, et al. Incidence and burden of tricuspid regurgitation in patients with atrial fibrillation. Journal of the American College of Cardiology. 2022;80:2289.

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