title: Predictors of reversible severe functional tricuspid regurgitation in patients with atrial fibrillation.
abstract: Atrial remodeling associated with atrial fibrillation (AF) is known to be a risk factor for significant tricuspid regurgitation (TR), but the predictor of reversible TR in patients with severe functional TR and AF has been poorly studied. The aim of this study was to investigate the predictors of reversible TR in patients with severe functional TR and AF.
  
  
  
  Among 232 patients with severe TR, a total of 71 patients with severe functional TR and AF were enrolled and divided into 2 groups: reversible TR group (n=16, 70.1±15.5 years, 7 males) vs. non-reversible TR group (n=55, 72.3±11.8 years, 20 males). Improvement of TR to moderate or lesser degree on follow-up (FU) echocardiography was considered as reversible TR in the present study.
  
  
  
  During 38.9±26.7 months of FU period, reversible TR was observed in 16 patients (22.5%). The presence of left ventricular (LV) systolic dysfunction was significantly prevalent (43.8% vs. 20.0%, p=0.03) and the improvement in LV ejection fraction (EF) more than 10% on FU echocardiography was more significantly frequent (62.5% vs. 23.3%, p=0.003) in the reversible TR group than in the non-reversible TR group. However, the other echocardiographic parameters, including right ventricular function were not different between the groups. In multivariate analysis using Cox proportional hazard model, the improvement of LVEF more than 10% was the only independent predictor of reversible TR (HR=7.39, 95%CI 1.80-30.28, p=0.005). Nine patients died only in patients with non-reversible TR (12.7%), but the reversibility of TR was not associated with mortality.
  
  
  
  The improvement of LV systolic function was the only independent predictor of reversible TR. Appropriate medical therapy including management for heart failure should be considered before performing surgery in patients with severe functional TR and AF, especially in patients with LV dysfunction.
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jae Yeong
authors.initials: JY
authors.lastname: Cho
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: christiankyehun@hanmail.net.
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jong Yoon
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Doo Sun
authors.initials: DS
authors.lastname: Sim
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Hyun Ju
authors.initials: HJ
authors.lastname: Yoon
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Nam Sik
authors.initials: NS
authors.lastname: Yoon
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jeong Gwan
authors.initials: JG
authors.lastname: Cho
authors.affiliation: Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Translational Research Center on Aging, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000150:complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D014262:Tricuspid Valve Insufficiency / Q000150:complications* / Q000628:therapy*
keywords: Atrial fibrillation; Mortality; Reversibility; Tricuspid regurgitation