Influence of Rhythm Control on Functional Mitral and Tricuspid Regurgitation Severity and Clinical Outcome in Patients With Atrial Fibrillation: A Propensity-Matched Cohort Study

Figure 1. Trajectories in MR and TR severity stratified by AF rhythm control therapy. Trends in functional MR and TR, stratified by rhythm control therapy, were visualized using the Sankey diagram. Interval changes in moderate or greater MR and TR were further analysed according to the rhythm control therapy. AF = atrial fibrillation; MR = mitral regurgitation; TR = tricuspid regurgitation.

Figure 2. Interval changes in moderate or greater regurgitation according to AF rhythm control therapy and follow-up rhythm status. The impact of rhythm control therapy on subsequent changes in moderate or greater functional regurgitation was analysed according to the rhythm status at follow-up echocardiography. AF = atrial fibrillation; MR = mitral regurgitation; SR = sinus rhythm; TR = tricuspid regurgitation.

Figure 3. Interval changes in moderate or greater regurgitation and echocardiographic features according to AF rhythm control therapy in patients with progressed AF status. The impact of AF rhythm control therapy on functional regurgitation and cardiac remodelling was analysed in patients with progressed AF status, characterized by enlarged LV volume, and in those with persistent AF. AF = atrial fibrillation; EF = ejection fraction; LA = left atrial; LAVI = left atrial volume index; LVEF = left ventricular ejection fraction; MR = mitral regurgitation; TR = tricuspid regurgitation.

Figure 4. Path diagrams of relationship between AF rhythm control therapy, improved regurgitation status or sinus restoration, and clinical outcome. The path diagrams illustrated the associations between rhythm control therapy, improved regurgitation status or sinus restoration, and clinical outcomes. The direct and indirect effects of rhythm control therapy were represented by coefficients along each path, serving as effect estimates. AF = atrial fibrillation; HF = heart failure; MR = mitral regurgitation; SE = standard error; TR = tricuspid regurgitation.

Figure 5. Clinical outcome according to AF RC therapy and associated functional regurgitation and rhythm status. The event curves for clinical outcomes were displayed based on RC therapy, with additional stratification by improved regurgitation status and sinus restoration at follow-up echocardiography. AF = atrial fibrillation; HR = hazard ratio; MR = mitral regurgitation; NRC = no rhythm control; RC = rhythm control; SR = sinus rhythm; TR = tricuspid regurgitation.

Figure 6. Subgroup analysis of outcome risk associated with AF rhythm control therapy. The outcome risk associated with the rhythm control therapy was examined across diverse clinical presentations, considering baseline MR and TR severity, AF chronicity, cardiac remodelling features, and associated comorbidities. AF = atrial fibrillation; BMI = body mass index; CI = confidence interval; HR = hazard ratio; LAVI = left atrial volume index; LVEF = left ventricular ejection fraction; MR = mitral regurgitation; TR = tricuspid regurgitation.