Progression of mitral and tricuspid regurgitation in patients with and without atrial fibrillation

Background: Mitral (MR) and tricuspid regurgitation (TR) are common valvular disorders that may progress over time. Atrial fibrillation (AF) affects atrial structure and may contribute to the progression of MR or TR. However, longitudinal data quantifying progression rates are limited. We aimed to assess MR and TR progression in patients with and without AF. Methods: A total of 412 patients with and without AF from the Swiss-AF and BEAT-AF cohorts between 2010 and 2023 were studied. MR and TR severity were graded using the first and last available transthoracic echocardiogram (TTE). The primary endpoint was any progression. Clinically relevant progression additionally required at least moderate severity on the second TTE. Multivariable logistic regression analyses were performed to examine the association between AF and progression of MR or TR. Results: Median age at first TTE was 74 years (IQR: 69-81, 26% female). Incidence rates of any MR progression were 7.3 vs. 15.0 and of clinically relevant progression 3.3 vs. 3.9 per 100 person-years in AF vs. non-AF patients. For TR, incidence rates were 9.9 vs. 8.9 and 5.2 vs. 2.1 per 100 person-years, respectively. In multivariable analyses, AF was independently associated with both a higher likelihood of any TR progression and clinically relevant TR progression, but not with MR progression. Conclusion: clinicaltrial.gov, identifier NCT02105844.