title: Clinical and Echocardiographic Factors Affecting Tricuspid Regurgitation Severity in the Patients with Lone Atrial Fibrillation.
abstract: 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. 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). TR severity was related to right atrial area and tricuspid annular systolic diameter (all p < 0.001). The patients with moderate or severe TR had larger left atrial (LA) volume and increased systolic pulmonary artery pressure (SPAP) than the patients with mild TR (p = 0.04 for LA volume; p < 0.001 for SPAP). RV remodeling represented by enlarged RV area and increased tenting height was more prominent in severe TR than mild or moderate TR (all p < 0.001). Multivariate analysis showed type of AF, LA volume, tricuspid annular diameter and tenting height remained as a significant determinants of severe TR. In addition, tenting height was independently associated with the presence of severe TR (p = 0.04).
  
  
  CONCLUSIONS
  In patients with lone AF, TR was related to type of AF, LA volume, tricuspid annular diameter and RV remodeling. Especially, tricuspid valvular tethering seemed to be independently associated with development of severe functional TR.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Sung-Hee
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Man-Jong
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Myung-Dong
authors.initials: MD
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Hyun-Ik
authors.initials: HI
authors.lastname: Shim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Jaewoong
authors.initials: J
authors.lastname: Yoon
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Sehwan
authors.initials: S
authors.lastname: Oh
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Dae-Hyeok
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Sang-Don
authors.initials: SD
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Sung-Woo
authors.initials: SW
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Seong-Ill
authors.initials: SI
authors.lastname: Woo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Keum-Soo
authors.initials: KS
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Kwan
keywords: Atrial fibrillation; Tenting height; Tricuspid regurgitation