Are Patients Diagnosed With AFib at Greater Risk For Tricuspid Valve Regurgitation?

Patients with atrial fibrillation (AFib) frequently develop significant tricuspid valve regurgitation (TR), with nearly one-third of patients developing moderate or greater TR, according to a study published Dec. 5  in JACC.

Sri Harsha Patlolla, MBBS, MS, et al., used a population-based record linkage system of the Rochester Epidemiology Project to identify patients with new-onset AFib between Jan. 1, 2001 and Dec. 31, 2014, and sought to determine the incidence of clinically significant isolated TR and its impact in patients with AFib. Patients with evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery or impaired left ventricular systolic/diastolic function at baseline were excluded.

The study cohort consisted of 691 patients (median age, 68 years; 38.9% women) and was followed until death or the latest available clinical evaluation through Nov. 30, 2021. The most common comorbidities were dyslipidemia, hypertension and diabetes. Two-thirds (64%) of the cohort was later diagnosed with permanent or persistent AFib and 36% with recurrent paroxysmal AFib.

Results showed 232 patients (33.6%) developed moderate or greater TR, and 10.6% of those patients had isolated TR without significant underlying structural heart disease. The incidence rate of any moderate or greater TR was 3.9 cases per 100 person-years, while the rate for isolated TR was 1.3 cases per 100 person-years. The cumulative incidence of significant TR was 16.0%, 29.8% and 38.1% at five, 10 and 15 years after new-onset AFib.

The risk of developing TR was greater in women (hazard ratio [HR], 1.83) and in patients with permanent/persistent AFib. The use of rhythm control was associated with a lower risk of developing TR (HR, 0.71).

Over the median 13.3 years of follow-up, the adjusted risk of subsequent mortality was higher in patients who developed moderate or greater TR (HR, 2.92; 95% CI, 2.29-3.73; p<0.001) and isolated significant TR (HR, 1.51; 95% CI, 1.03-2.22; p=0.03).

The authors write that in this population “incident significant TR of any cause was associated with more than two-fold increased risk of mortality, and incident isolated significant TR was associated with 51% greater risk of death in patients with AFib.”

In an accompanying editorial comment, Tobias Friedrich Ruf, MD, PhD, et al., write that although a causal relationship between AFib and incident isolated TR cannot be proven, that “the excessive incidence of 31.5% of isolated TR in a cohort of new-onset AFib demonstrates the close association between the two, as does the observation that early rhythm control reduces this risk.”

Explore this study more with ACC’s Incidence and Burden of TR in Patients with AFib free educational activity with CME/MOC credit.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Dyslipidemias, Heart Diseases, Tricuspid Valve Insufficiency, Atrial Fibrillation, Tricuspid Valve, Follow-Up Studies

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