title: Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation: A Real-Time 3-Dimensional Transesophageal Echocardiography Study.
abstract: BACKGROUND
  Functional tricuspid regurgitation (TR) with a structurally normal tricuspid valve (TV) may occur secondary to chronic atrial fibrillation (AF). However, the clinical and echocardiographic differences according to functional TR subtypes are unclear. Therefore, characterization of functional TR because of chronic AF (AF-TR) remains undetermined.
  
  
  RESULTS
  To investigate the prevalence of AF-TR, 437 patients with moderate to severe TR underwent 3-dimensional (3D) transesophageal echocardiography. TR severity was determined by the averaged vena contracta width on apical and parasternal inflow views. The prevalence of AF-TR was 9.2%, whereas that of functional TR because of left-sided heart disease was 45.3%. Clinical features of AF-TR included advanced age, female sex, greater right atrial than left atrial enlargement and lower systolic pulmonary artery pressure compared with left-sided heart disease-TR with sinus rhythm (all P<0.05). In 3D TV assessment, patients with AF-TR had a larger TV annular area with weaker annular contraction (both P<0.001) but a smaller tethering angle (P<0.001) despite a similar leaflet coaptation status compared with patients with left-sided heart disease-TR with sinus rhythm. On multivariable analysis, only the TV annular area in midsystole (coefficient, 0.059; 95% confidence interval, 0.041-0.078 per 100 mm2; P<0.001) was associated with TR severity in AF-TR. The annular area was more closely correlated with the right atrial volume than right ventricular end-systolic volume in AF-TR (P<0.001).
  
  
  CONCLUSIONS
  AF-TR is not rare and is associated with advanced age and right atrial enlargement. TV deformations and their association with right heart remodeling differ between AF-TR and left-sided heart disease-TR. Our results suggest that in patients with TR secondary to AF, TV annuloplasty should be effective because this entity has annular dilatation without leaflet deformation.
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itabashi
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Mihara
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Javier
authors.initials: J
authors.lastname: Berdejo
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Sayuki
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.affiliation: From Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.U., Y.I., H.M., J.B., S.K., R.J.S., T.S.); and University of California, Los Angeles (R.J.S., T.S.). ShiotaT@cshs.org.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D016280:Atrial Function, Right; D064752:Atrial Remodeling; D002908:Chronic Disease; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling
keywords: atrial fibrillation; echocardiography, transesophageal; tricuspid valve; tricuspid valve insufficiency