Andrada C Guta1, Luigi P Badano2, Michele Tomaselli3, Diana Mihalcea1, Daniela Bartos4, Gianfranco Parati3, Denisa Muraru3. 1. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Cardiological, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca Clinico a Carattere Scientifico, San Luca Hospital, Milan, Italy. 2. Department of Cardiological, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca Clinico a Carattere Scientifico, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. Electronic address: luigi.badano@unimib.it. 3. Department of Cardiological, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Istituto di Ricerca Clinico a Carattere Scientifico, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy. 4. Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
Abstract
BACKGROUND: Atrial fibrillation (AF) itself may lead to functional tricuspid regurgitation (FTR) through tricuspid annulus (TA) dilation. However, the pathophysiological determinants of TA enlargement in AF patients remain to be clarified. The objectives of this study were (1) to compare the TA size and function in AF patients versus healthy subjects; (2) to identify the determinants of TA remodeling in patients with AF and FTR; and (3) to assess the relationships among right heart structures and severity of FTR in AF patients. METHODS: Eighty-three consecutive patients with long-term persistent AF and FTR (61 ± 9.9 years, 67% women) were prospectively enrolled and compared with 83 sex and body surface area-matched healthy subjects. Heart chamber size and function and TA geometry were analyzed using three-dimensional echocardiography. RESULTS: Among AF patients, 33%, 34%, and 33% had mild, moderate, and severe FTR, respectively. Right atrial (RA) dilation was detected in 93% of AF patients, while only 27% and 12% of them showed dilated or dysfunctional right ventricle (RV), respectively. End-diastolic TA area had the strongest correlation with the minimum volume of the RA (RAVmin r = 0.6981, P < .0001) but only mild correlation with RV end-diastolic volume and sex (r = 0.3405, P = .0019; r = 0.2914, P = .0075). At multivariable analysis, only RAVmin was independently associated with TA area in AF patients (r = 0.665, P < .0001). The RAVmin and TA area were the only predictors of FTR severity. CONCLUSIONS: In patients with AF, RA dilation seems to be more important than RV dilation to determine TA enlargement and subsequent FTR development. The RAVmin and TA area were directly correlated to FTR severity.
BACKGROUND:Atrial fibrillation (AF) itself may lead to functional tricuspid regurgitation (FTR) through tricuspid annulus (TA) dilation. However, the pathophysiological determinants of TA enlargement in AFpatients remain to be clarified. The objectives of this study were (1) to compare the TA size and function in AFpatients versus healthy subjects; (2) to identify the determinants of TA remodeling in patients with AF and FTR; and (3) to assess the relationships among right heart structures and severity of FTR in AFpatients. METHODS: Eighty-three consecutive patients with long-term persistent AF and FTR (61 ± 9.9 years, 67% women) were prospectively enrolled and compared with 83 sex and body surface area-matched healthy subjects. Heart chamber size and function and TA geometry were analyzed using three-dimensional echocardiography. RESULTS: Among AFpatients, 33%, 34%, and 33% had mild, moderate, and severe FTR, respectively. Right atrial (RA) dilation was detected in 93% of AFpatients, while only 27% and 12% of them showed dilated or dysfunctional right ventricle (RV), respectively. End-diastolic TA area had the strongest correlation with the minimum volume of the RA (RAVmin r = 0.6981, P < .0001) but only mild correlation with RV end-diastolic volume and sex (r = 0.3405, P = .0019; r = 0.2914, P = .0075). At multivariable analysis, only RAVmin was independently associated with TA area in AFpatients (r = 0.665, P < .0001). The RAVmin and TA area were the only predictors of FTR severity. CONCLUSIONS: In patients with AF, RA dilation seems to be more important than RV dilation to determine TA enlargement and subsequent FTR development. The RAVmin and TA area were directly correlated to FTR severity.
Authors: Denisa Muraru; Mara Gavazzoni; Francesca Heilbron; Diana J Mihalcea; Andrada C Guta; Noela Radu; Giuseppe Muscogiuri; Michele Tomaselli; Sandro Sironi; Gianfranco Parati; Luigi P Badano Journal: Front Cardiovasc Med Date: 2022-09-13