Key result
Significant isolated tricuspid regurgitation in atrial fibrillation was associated with increased risk of mortality, heart failure hospitalization, and stroke (HR 2.853; 95% CI 1.458-5.584; p=0.002).
Why the study?
The prognostic impact of isolated tricuspid regurgitation in patients with atrial fibrillation had not been investigated.
Does significant isolated tricuspid regurgitation increase the risk of all-cause mortality, heart failure hospitalization, and stroke in patients with atrial fibrillation without left-sided heart disease or pulmonary hypertension?
Cohort (n=179)
Does significant isolated tricuspid regurgitation increase the risk of all-cause mortality, heart failure hospitalization, and stroke in patients with atrial fibrillation without left-sided heart disease or pulmonary hypertension?
Hazard Ratio: 2.853 (95% CI 1.458–5.584)
Absolute Event Rate: 56% vs 85%
p-value: p=0.002
In patients with atrial fibrillation without left-sided heart disease or pulmonary hypertension, significant isolated tricuspid regurgitation is independently associated with an increased risk of mortality, heart failure hospitalization, and stroke.
May warrant closer surveillance in AF without left-sided disease; leaves open whether TR correction improves outcomes.
The prognostic impact of isolated tricuspid regurgitation (TR) in patients with atrial fibrillation (AF) has not been investigated. The purpose of this study was to investigate the prognostic implications of significant isolated TR in AF patients without left-sided heart disease, pulmonary hypertension, or primary structural abnormalities of the tricuspid valve. A total of 63 AF patients with moderate and severe TR were matched for age and gender to 116 AF patients without significant TR. Patients were followed for the occurrence of all-cause mortality, hospitalization for heart failure and stroke. Patients with significant isolated TR (mean age 71 ± 8 years, 57% men) more often had paroxysmal AF as compared with patients without TR (mean age 71 ± 7 years, 60% men) (60% vs 43%, p = 0.028). In addition, right atrial size and tricuspid annular diameter were significantly larger in patients with significant isolated TR compared with their counterparts. During follow-up (median 62 [34 to 95] months), 53 events for the combined endpoint occurred. One- and 5-year event-free survival rates for patients with significant isolated TR were 76% and 56%, compared with 92% and 85% for patients without significant TR, respectively (Log rank Chi-Square p <0.001). The presence of significant isolated TR was independently associated with the combined endpoint (hazard ratio, 2.853; 95% confidence interval, 1.458 to 5.584; p = 0.002). In conclusion, in the absence of left-sided heart disease and pulmonary hypertension, significant isolated TR is independently associated with worse event-free survival in patients with AF.
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Dietz et al. (2020) conducted a cohort in Atrial fibrillation without left-sided heart disease or pulmonary hypertension (n=179). Significant isolated tricuspid regurgitation vs. No significant tricuspid regurgitation was evaluated on Combined endpoint of all-cause mortality, hospitalization for heart failure and stroke (HR 2.853, 95% CI 1.458-5.584, p=0.002). Significant isolated tricuspid regurgitation in atrial fibrillation was associated with increased risk of mortality, heart failure hospitalization, and stroke (HR 2.853; 95% CI 1.458-5.584; p=0.002).
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