title: Frequency and Associated Clinical Features of Functional Tricuspid Regurgitation in Patients With Chronic Atrial Fibrillation.
abstract: Significant functional tricuspid regurgitation (TR) can develop in some but not all patients with chronic atrial fibrillation (AF). This study sought to identify factors likely to be involved in determining the severity of TR in patients with chronic AF. In this retrospective cohort study of adult patients referred for transthoracic echocardiography for evaluation of AF between 2004 and 2015, we identified 170 patients with chronic AF in the absence of structural or known coronary heart disease. Patients were classified into nonsevere (89 patients) versus severe TR (81 patients) groups based on a comprehensive assessment of color Doppler, spectral Doppler, and morphologic parameters of the tricuspid valve and right side of the heart. Patients with severe TR were significantly older (76 ± 10 vs 70 ± 11, p <0.001), with smaller body surface area (1.7 ± 0.3 m2vs 1.9 ± 0.23 m2, p = 0.001) and with female predominance (percentage of men 30% vs 57%, p <0.001). Although comorbidities, use of cardiovascular medications, and left-sided cardiac parameters were statistically indistinguishable between these 2 groups, right-sided cardiac dimensions, tricuspid valve tethering height, and tricuspid valve tethering area were significantly larger in the severe TR group. A comprehensive multivariate logistic regression model (model 1) identified the age, gender, right ventricular systolic pressure, right atrial volume index, and right ventricular end-diastolic area as independent factors associated with TR severity. A simplified logistic regression model using only clinical factors (model 2) confirmed the age, gender, and right ventricular systolic pressure as clinically relevant factors in relation to TR.
authors.affiliation: Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA. Electronic address: susanxzhao@gmail.com.
authors.forename: Susan X
authors.initials: SX
authors.lastname: Zhao
authors.affiliation: Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA.
authors.forename: Nima
authors.initials: N
authors.lastname: Soltanzad
authors.affiliation: Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA.
authors.forename: Aravind
authors.initials: A
authors.lastname: Swaminathan
authors.affiliation: Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA.
authors.forename: W David
authors.initials: WD
authors.lastname: Ogden
authors.affiliation: Division of Cardiology, University of California, San Francisco, San Francisco, CA.
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001794:Blood Pressure; D002908:Chronic Disease; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology*