Prevalence and factors associated with atrial mitral and tricuspid regurgitation in patients with atrial fibrillation.
atrial fibrillation
atrial mitral regurgitation
atrial tricuspid regurgitation
echocardiography
pulmonary hypertension
Journal
Echocardiography (Mount Kisco, N.Y.)
ISSN: 1540-8175
Titre abrégé: Echocardiography
Pays: United States
ID NLM: 8511187
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
15
07
2021
received:
28
05
2021
accepted:
06
11
2021
pubmed:
1
12
2021
medline:
27
1
2022
entrez:
30
11
2021
Statut:
ppublish
Résumé
This study aimed to examine the prevalence of atrial tricuspid regurgitation (ATR) and atrial mitral regurgitation (AMR) in the setting of atrial fibrillation (AFib) and identify variables related to the severity of both types of regurgitation. Cross-sectional study evaluating data from transthoracic echocardiograms performed during 2019. We included patients with AFib during the examination, and without primary valve disease or other significant heart disease. Four-hundred and thirty-two patients fulfilled the inclusion criteria (mean age 77.5±9.2 years, 49.1% women). We observed significant ATR in 14.8%, and significant AMR in 1.4% of patients. ATR and AMR severities were equal in 49.3% of patients, and 41% displayed greater ATR severity. ATR prevalence was significantly greater among women (23.1% vs 6.8%, p < 0.001), but AMR prevalence was similar between genders (1.9% vs .9%, p = 0.443). Variables related to greater ATR severity were: female sex (OR: 2.61, 95%CI: 1.60-4.24), left atrial (LA) volume (OR: 3.58, 95%CI: 1.50-8.55), systolic pulmonary artery pressure (OR: 1.10, 95%CI: 1.07-1.13), and moderate AMR (OR: 2.21, 95%CI: 1.22-4.00). Variables related to greater AMR severity were female sex (OR: 1.96, 95%CI: 1.24-3.09), LA volume (OR: 11.68, 95%CI: 5.29-25.80), and body mass index (OR: .94, 95%CI: .90-.98). In the context of AFib, ATR was more prevalent than AMR and prevailed in women. LA enlargement was associated with higher degrees of both AMR and ATR. Pulmonary hypertension was also independently associated with ATR, as well as greater AMR severity, suggesting possible adaptive changes in leaflets that might modify the atrial regurgitation incidence.
Sections du résumé
BACKGROUND
This study aimed to examine the prevalence of atrial tricuspid regurgitation (ATR) and atrial mitral regurgitation (AMR) in the setting of atrial fibrillation (AFib) and identify variables related to the severity of both types of regurgitation.
METHODS
Cross-sectional study evaluating data from transthoracic echocardiograms performed during 2019. We included patients with AFib during the examination, and without primary valve disease or other significant heart disease.
RESULTS
Four-hundred and thirty-two patients fulfilled the inclusion criteria (mean age 77.5±9.2 years, 49.1% women). We observed significant ATR in 14.8%, and significant AMR in 1.4% of patients. ATR and AMR severities were equal in 49.3% of patients, and 41% displayed greater ATR severity. ATR prevalence was significantly greater among women (23.1% vs 6.8%, p < 0.001), but AMR prevalence was similar between genders (1.9% vs .9%, p = 0.443). Variables related to greater ATR severity were: female sex (OR: 2.61, 95%CI: 1.60-4.24), left atrial (LA) volume (OR: 3.58, 95%CI: 1.50-8.55), systolic pulmonary artery pressure (OR: 1.10, 95%CI: 1.07-1.13), and moderate AMR (OR: 2.21, 95%CI: 1.22-4.00). Variables related to greater AMR severity were female sex (OR: 1.96, 95%CI: 1.24-3.09), LA volume (OR: 11.68, 95%CI: 5.29-25.80), and body mass index (OR: .94, 95%CI: .90-.98).
CONCLUSIONS
In the context of AFib, ATR was more prevalent than AMR and prevailed in women. LA enlargement was associated with higher degrees of both AMR and ATR. Pulmonary hypertension was also independently associated with ATR, as well as greater AMR severity, suggesting possible adaptive changes in leaflets that might modify the atrial regurgitation incidence.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2043-2051Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.
Deferm S, Bertrand PB, Verbrugge FH, et al. Atrial functional mitral regurgitation: Jacc review topic of the week. J Am Coll Cardiol. 2019;73:2465-2476.
Silbiger JJ. Atrial functional tricuspid regurgitation: an underappreciated cause of secondary tricuspid regurgitation. Echocardiography. 2019;36:954-957.
Gertz ZM, Raina A, Saghy L, et al. Evidence of atrial functional mitral regurgitation due to atrial fibrillation: reversal with arrhythmia control. J Am Coll Cardiol. 2011;58:1474-1481.
Tamargo M, Obokata M, Reddy YNV, et al. Functional mitral regurgitation and left atrial myopathy in heart failure with preserved ejection fraction. Eur J Heart Fail. 2020;22:489-498.
Prihadi EA, Delgado V, Leon MB, Enriquez-Sarano M, Topilsky Y, Bax JJ. Morphologic types of tricuspid regurgitation: characteristics and prognostic implications. JACC Cardiovasc Imag. 2019;12:491-499.
Zhou X, Otsuji Y, Yoshifuku S, et al. Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation. Circ J. 2002;66:913-916.
Russo C, Hahn RT, Jin Z, Homma S, Sacco RL, Di Tullio MR. Comparison of echocardiographic single-plane versus biplane method in the assessment of left atrial volume and validation by real time three-dimensional echocardiography. J Am Soc Echocardiogr. 2010;23:954-960.
Lancellotti P, Tribouilloy C, Hagendorff A, et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imag. 2013;14:611-644.
Tsang TS, Abhayaratna WP, Barnes ME, et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?. J Am Coll Cardiol. 2006;47:1018-1023.
Topilsky Y, Khanna A, Le Tourneau T, et al. Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension. Circ Cardiovasc Imag. 2012;5:314-323.
Bisbal F, Baranchuk A, Braunwald E, Bayés de Luna A, Bayés-Genís A. Atrial failure as a clinical entity: JACC review topic of the week. J Am Coll Cardiol. 2020;75:222-232.
Abe Y, Akamatsu K, Ito K, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J. 2018;82:1451-1458.
Muraru D, Guta AC, Ochoa-Jimenez RC, et al. Functional Regurgitation of atrioventricular valves and atrial fibrillation: an elusive pathophysiological link deserving further attention. J Am Soc Echocardiogr. 2020;33:42-53.
Fukuda S, Saracino G, Matsumura Y, et al. Three-dimensional geometry of the tricuspid annulus in healthy subjects and in patients with functional tricuspid regurgitation: a real-time, 3-dimensional echocardiographic study. Circulation. 2006;114:I492-8.
Pozzoli A, Zuber M, Reisman M, Maisano F, Taramasso M. Comparative anatomy of mitral and tricuspid valve: what can the interventionlist learn from the surgeon. Front Cardiovasc Med. 2018;5:80.
Singh JP, Evans JC, Levy D, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study). Am J Cardiol. 1999;83:897-902.
Ong K, Yu G, Jue J. Prevalence and spectrum of conditions associated with severe tricuspid regurgitation. Echocardiography. 2014;31:558-562.
Zhao SX, Soltanzad N, Swaminathan A, Ogden WD, Schiller NB. Frequency and associated clinical features of functional tricuspid regurgitation in patients with chronic atrial fibrillation. Am J Cardiol. 2017;119:1371-1377.
Mutlak D, Aronson D, Lessick J, Reisner SA, Dabbah S, Agmon Y. Functional tricuspid regurgitation in patients with pulmonary hypertension: is pulmonary artery pressure the only determinant of regurgitation severity?. Chest. 2009;135:115-121.
El-Busaid H, Hassan S, Odula P, Ogeng'o J, Ndung'u B. Sex variations in the structure of human atrioventricular annuli. Folia Morphol (Warsz). 2012;71:23-27.
Chaput M, Handschumacher MD, Tournoux F, et al. Mitral leaflet adaptation to ventricular remodeling: occurrence and adequacy in patients with functional mitral regurgitation. Circulation. 2008;118:845-852.
Kim DH, Heo R, Handschumacher MD, et al. Mitral valve adaptation to isolated annular dilation: insights into the mechanism of atrial functional mitral regurgitation. JACC Cardiovasc Imag. 2019;12:665-677.
Afilalo J, Grapsa J, Nihoyannopoulos P, et al. Leaflet area as a determinant of tricuspid regurgitation severity in patients with pulmonary hypertension. Circ Cardiovasc Imag. 2015;8:e002714.
Otsuji Y, Kumanohoso T, Yoshifuku S, et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy. J Am Coll Cardiol. 2002;39:1651-1656.
Dziadzko V, Dziadzko M, Medina-Inojosa JR, et al. Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J. 2019;40:2194-2202.