Abstract 14338: Functional Tricuspid Regurgitation Associated With Degenerative Mitral Valve Disease: Critical Role of Atrial Fibrillation
Introduction: Functional Tricuspid Regurgitation (FTR) associated with Degenerative Mitral Valve Disease (DMVD) is mainly considered consequent to pulmonary hypertension (PHTN) or ventricular dysfunction. Recent reports linked presence of atrial fibrillation (AF) to FTR severity but large data in DMVD are lacking.
Methods and results: Patients diagnosed with isolated DMVD (no aortic valve diseases, valve surgery or pericardial/myocardial disease) with mitral prolapse with or without mitral regurgitation (MR) and with FTR (excluding pace maker or tricuspid valve prolapse) were enrolled between 2003 and 2011 at Mayo Clinic. Among 5083 patients with isolated DMVD (age 63±16 years), 10% had moderate or severe FTR and 14% had AF. Compared to trivial/mild FTR, patients with moderate-severe FTR were older (76±12 vs 62 ±16 years, p<0.0001) and more likely to be female (54% vs 46% p 0.0007). Moderate-severe FTR was [VTN1] associated with more frequent dyspnea (55% vs 34%, p<0.0001), larger right ventricle (p<0.0001), and lower cardiac index (2.8±0.7 vs 3.0.±0.6, p<0.0001). Association of AF with moderate-severe FTR was strong in univariate (OR 7.8 [6.4-9.5] p<0.0001) and in multivariate analysis (OR 4.5 [3.5-5.7] p<0.0001) adjusting for age, sex, pulmonary pressure, MR severity, left ventricular function and previous coronary bypass. Subgroup analysis (Table) demonstrated that in all subsets of DMVD AF is significantly associated with moderate or severe TR with high Odds Ratio.
Conclusion: In patients with DMVD, moderate to severe FTR is frequent and is independently associated to the AF, regardless of MR severity, PHTN, and left ventricular function. These data emphasize the fact that, beyond conventional determinants of FTR, there is a prominent association between AF and FTR observed in DMVD, which should be considered in the clinical evaluation of these patients.
Author Disclosures: C. Antoine: None. G. Benfari: None. H.I. Michelena: None. J.F. Malouf: None. V.T. Nkomo: None. M. Enriquez-Sarano: None.
- © 2016 by American Heart Association, Inc.