Abstract 16434: Atrial Fibrillation Is Associated With Significative Functional Tricuspid Regurgitation In Patients With Left Ventricular Dysfunction
Introduction: Functional tricuspid valve regurgitation (FTR) is common in patients with left ventricular (LV) dysfunction and is usually ascribed to pulmonary hypertension (PHTN) or to reduced ejection fraction (EF). Recent reports linked atrial Fibrillation (AF) to severe FTR but such association has not been analyzed in LV dysfunction.
Hypothesis: AF is associated to FTR severity independently of other characteristics of LV dysfunction.
Methods: Patients diagnosed with LV dysfunction (EF <50%) by Doppler-Echocardiography at Mayo Clinic 2003-2012 with measurable pulmonary pressure were enrolled. Patients with organic valve disease, previous valve surgery, hypertrophic or infiltrative myocardial disease, pacemaker or defibrillator were excluded.
Results: In the 12,073 patients enrolled age was 68±14 years, 34% were female, EF was 36±10%, pulmonary pressure 41±14 mmHg, and 20% (N=2425) were in AF. FTR was moderate in 20% (N=2390) and severe in 7% (N=797) and was independently associated with clinical consequences, more dyspnea (62 vs 50%, p<0.0001), impaired renal function (53 vs 34%, p<0.0001), and history of heart failure (63 vs 46%, p<0.0001) vs. those with trivial or mild FTR.Association of AF with moderate or severe FTR was strong in univariate analysis (OR: 3.01 [2.74-3.31]; p<0.0001) and even stronger in multivariable analysis adjusting for age, sex, mitral regurgitation, EF, right ventricular (RV) dysfunction and PHTN (OR: 3.30 [2.96-3.68]; p<0.0001). Stratified by major FTR predictors, the association of AF with moderate or severe FTR shown in Table 1, was highly significant in all subgroups.
Conclusions: In patients with LV dysfunction moderate or severe FTR is 1 - frequent; 2 - associated with notable clinical consequences and 3 - strongly linked to the presence of AF independently of all baseline characteristics and in all patients’ subgroups. Hence, LV dysfunction patients, the presence of AF should lead to careful evaluation for associated FTR.
Author Disclosures: G. Benfari: None. C. Antoine: None. W.L. Miller: None. H.I. Michelena: None. V.T. Nkomo: None. M. Enriquez-Sarano: None.
- © 2016 by American Heart Association, Inc.