Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right‐Sided Heart Remodeling After Mitral‐Valve Surgery: A Propensity‐Score Matching Analysis

Figures

• 

  Figure 1. Propensity‐score matching for the total cohort (n=1568, 408 in ablated group, and 1160 in the nonablated group). A, Dot plot of patients in either matched or unmatched groups. B, Line plot of standardized differences before and after matching. C, Dot plot of standardized mean differences (Cohen's d) for all covariates before and after matching. D, Distribution of propensity scores of ablated (“treated”) and nonablated patients (“control”) before and after matching with overlaid kernel density estimate. E, Histograms with overlaid kernel density estimates of standardized differences before and after matching. ACEI indicates angiotensin‐converting enzyme inhibitor; ACT, aortic clamp time; ARB, angiotensin receptor blocker; BMI, body mass index; BSA, body surface area; CABG, coronary artery bypass graft; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass; LAD, left atrial diameter; LVEDD, left ventricle end‐diastolic dimension; LVEF, left ventricle ejection fraction; LVESD, left ventricle end‐systolic dimension; MVOP, mitral valve operation; NYHA, New York Heart Association; RA, right atrial; RVFAC, right ventricle fractional area…

• 

  Figure 2. Comparison of outcomes in the overall cohort. Kaplan–Meier curves showing patient survival: overall mortality (A), stroke (B), reoperation (C), and moderate‐to‐severe tricuspid regurgitation (D) in the cohort. HR indicates hazard ratio; TR, tricuspid regurgitation.

• 

  Figure 3. Combination chart distribution of reoperation. Combination chart showing the extent of reoperation in the nonablated (A) and ablated groups (B) in the overall cohort. AVR indicates aortic valve replacement; CABG, coronary artery bypass graft; HR, hazard ratio; IE, infective endocarditis; MR, mitral regurgitation; PVL, paravalvular leak; TR, tricuspid regurgitation.

• 

  Figure 4. Comparison of outcomes in the PSM cohort. Kaplan–Meier curves of patient survival: overall mortality (A), stroke (B), reoperation (C), and moderate‐to‐severe tricuspid regurgitation (D) in the PSM cohort. HR indicates hazard ratio; PSM, propensity‐score matching; TR, tricuspid regurgitation.

• 

  Figure 5. Indices of heart function and echocardiography at baseline and after 5 years of follow‐up in the PSM cohort. A, Percentage of NYHA more than II at baseline and after 5 years of follow‐up in the PSM cohort. B, LAD at baseline and after 5 years of follow‐up in the PSM cohort. C, RA Area at baseline and after 5 years of follow‐up in the PSM cohort. D, RVSI at baseline and after 5 years of follow‐up in the PSM cohort. E, RVFAC at baseline and after 5 years of follow‐up in the PSM cohort. F, sPAP at baseline and after 5 years of follow‐up in the PSM cohort. G, TAD at baseline and after 5 years of follow‐up in the PSM cohort. H, Percentage of Diuretics use at baseline and after 5 years of follow‐up in the PSM cohort. LAD indicates left atrial diameter; NYHA, New York Heart Association; PSM, propensity‐score matching; RA, right atrial; RVFAC, right ventricle fraction area change; RVSI, right ventricle sphericity index; sPAP, pulmonary artery systolic pressure; TAD, tricuspid annulus diameter. *P<0.05 versus baseline. ▵ P<0.05 versus ablated group.

• 

  Figure 6. Kaplan–Meier curves for the survival of atrial fibrillation recurrence in the ablated group. AF indicates atrial fibrillation.

• 

  Figure 7. Propensity‐score matching for subgroup analysis in the ablated group (n=408, 257 in SR group, and 151 in recurrent group). A, Dot plot of patients in either matched or unmatched groups. B, Line plot of standardized differences before and after matching. C, Dot plot of standardized mean differences (Cohen's d) for all covariates before and after matching. D, Distribution of propensity scores of recurrent patients (“treated”) and SR patients (“control”) before and after matching with overlaid kernel density estimate. E, Histograms with overlaid kernel density estimates of standardized differences before and after matching. ACEI indicates angiotensin‐converting enzyme inhibitor; ACT, aortic clamp time; ARB, angiotensin receptor blocker; BMI, body mass index; BSA, body surface area; CABG, coronary artery bypass graft; CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; CPB, cardiopulmonary bypass; LAD, left atrial diameter; LVEDD, left ventricle end‐diastolic dimension; LVEF, left ventricle ejection fraction; LVESD, left ventricle end‐systolic dimension; MVOP, mitral valve operation; NYHA, New York Heart Association; RA, right atrial; RVFAC, right ventricle…

• 

  Figure 8. Kaplan–Meier curves for the survival of moderate‐to‐severe tricuspid regurgitation in (A), overall cohort and (B), PSM cohort of ablated group. HR indicates hazard ratio; PSM, propensity‐score matching; SR, sinus rhythm; TR, tricuspid regurgitation.

• 

  Figure 9. Indices of heart function and echocardiography at baseline and after 5 years of follow‐up in the PSM cohort of the ablated group. A, Percentage of NYHA more than II at baseline and after 5 years of follow‐up. B, LAD at baseline and after 5 years of follow‐up. C, RA Area at baseline and after 5 years of follow‐up. D, RVSI at baseline and after 5 years of follow‐up. E, RVFAC at baseline and after 5 years of follow‐up. F, sPAP at baseline and after 5 years of follow‐up. G, TAD at baseline and after 5 years of follow‐up. H, Percentage of diuretics use at baseline and after 5 years of follow‐up. LAD indicates left atrial diameter; NYHA, New York Heart Association; PSM, propensity‐score matching; RA, right atria; RVFAC, right ventricle fraction area change; RVSI, right ventricle sphericity index; sPAP, pulmonary artery systolic pressure; SR, sinus rhythm; TAD, tricuspid annulus diameter. *P<0.05 versus baseline. ▵ P<0.05 versus SR group.

• 

  Figure 10. Correlations between the time after recurrence and (A), LAD; (B), RA area; (C), sPAP; (D), RVSI; (D), RVFAC, and (F), TAD. AF indicates atrial fibrillation; LAD, left atrial diameter; RA, right atria; RVFAC, right ventricle fraction area change; RVSI, right ventricle sphericity index; sPAP, pulmonary artery systolic pressure; TAD, tricuspid annulus diameter.