Association Between Atrial Fibrillation and Tricuspid Regurgitation

Background and objective: Atrial fibrillation (AF) may contribute to the development of tricuspid regurgitation (TR) via tricuspid annular dilatation. We assessed the association between AF and TR in a large cohort of patients in clinical practice.

Methods: A total of 8,795 patients without a pacemaker electrode or prior tricuspid valve (TV) surgery and in sinus rhythm (SR) or AF during the echocardiographic examination were included in the analysis.

Results: None or mild TR was evident in 8,034 patients (91.3%), moderate TR in 600 (6.8%), and severe TR in 161 (1.8%). During echocardiography, 860 patients (9.8%) were in AF and 7952 (90.2%) had SR. Compared to patients with none or mild TR, patients with moderate or severe TR (combined) were characterized by older age, female predominance, lower left ventricular ejection fraction (LVEF), higher pulmonary artery systolic pressure (PASP), higher frequency of AF, right atrial (RA) and left atrial (LA) enlargement, right ventricle (RV) enlargement, RV dysfunction, and moderate or severe mitral regurgitation (MR) [Table 1]. By multi-variate logistic regression [Table 2], all above mentioned variables were found to be associated with moderate or severe TR, with the highest odds ratio (OR) for AF [OR 5.3, 95% confidence interval (CI) 3.8-7.3]. The presence of AF was also independently associated with severe TR (OR 2.5, CI 1.1-5.5), adjusting for the other risk factors for TR. After propensity score matching for multiple variables (Table 3 and Figure 1), AF was more frequent in patients with moderate or severe TR (34.2% vs. 16.9% in none or mild TR).

Conclusion: AF is strongly associated with significant TR, independent of other risk factors for TR.