Skip to main content
SpringerLink
Log in

Incremental value of tricuspid annular enlargement to progressive tricuspid regurgitation in patients with longstanding persistent atrial fibrillation

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Tricuspid annular enlargement in patients with atrial fibrillation (AF) can induce tricuspid regurgitation (TR). However, risk factors associated with TR progression in patients with AF have not been defined. This study aimed to clarify an association between tricuspid annular diameter (TAD) and TR progression in patients with longstanding persistent AF. We retrospectively analyzed data from 228 patients who had longstanding persistent AF for > 1 year and mild or less TR on baseline echocardiograms. We defined significant TR as moderate or greater TR, graded according to the jet area and vena contracta. The optimal cut-off value of the TAD index (TADI), based on body surface area for predicting progression to significant TR, was estimated using receiver operating characteristic (ROC) curves. The independence and incremental value of the TADI were evaluated using multivariate Cox proportional hazard regression analysis and likelihood ratio tests. Over a median follow-up of 3.7 years, 55 (24.1%) patients developed significant TR. The optimal cut-off value of 21.1 mm/m2 for the TADI at baseline and ROC curves predicted TR progression with 70.4% sensitivity and 86% specificity. Furthermore, TADI was an independent predictor of TR progression (hazard ratio, 1.32; 95% confidence interval, 1.17–1.49, P < 0.001) and had a significant incremental value that exceeded that of models constructed using clinical parameters. In conclusion, TADI was significantly associated with TR progression and was an independent predictor of TR progression in longstanding persistent AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The data supporting this study's findings are available from the corresponding author, [Masaki Kinoshita], upon reasonable request.

References

  1. Mutlak D, Lessick J, Reisner SA, Aronson D, Dabbah S, Agmon Y (2007) Echocardiography-based Spectrum of Severe Tricuspid Regurgitation: The Frequency of Apparently Idiopathic Tricuspid Regurgitation. J Am Soc Echocardiogr 20:405–408

    Article  PubMed  Google Scholar 

  2. Nath J, Foster E, Heidenreich PA (2004) Impact of Tricuspid Regurgitation on Long-Term Survival. J Am Coll Cardiol 43:405–409

    Article  PubMed  Google Scholar 

  3. Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM, Pislaru S, Park S, Mahoney DW, Biner S, Enriquez-Sarano M (2014) Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging 7:1185–1194

    Article  PubMed  Google Scholar 

  4. Topilsky Y, Maltais S, Medina Inojosa J, Oguz D, Michelena H, Maalouf J, Mahoney DW, Enriquez-Sarano M (2019) Burden of Tricuspid Regurgitation in Patients Diagnosed in the Community Setting. JACC Cardiovasc Imaging 12:433–442

    Article  PubMed  Google Scholar 

  5. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De BM, De PR, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sadaba JR, Tribouilloy C, Wojakowski W, Neumann FJ, Myers P, Abdelhamid M, Achenbach S, Asteggiano R, Barili F, Borger MA, Carrel T, Collet JP, Foldager D, Habib G, Hassager C, Irs A, Iung B, Jahangiri M, Katus HA, Koskinas KC, Massberg S, Mueller CE, Nielsen JC, Pibarot P, Rakisheva A, Roffi M, Rubboli A, Shlyakhto E, Siepe M, Sitges M, Sondergaard L, Sousa-Uva M (2022) 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 43:561–632

    Article  PubMed  Google Scholar 

  6. Najib MQ, Vinales KL, Vittala SS, Challa S, Lee HR, Chaliki HP (2012) Predictors for the development of severe tricuspid regurgitation with anatomically normal valve in patients with atrial fibrillation. Echocardiography 29:140–146

    Article  PubMed  Google Scholar 

  7. Zhou X, Otsuji Y, Yoshifuku S, Yuasa T, Zhang H, Takasaki K, Matsukida K, Kisanuki A, Minagoe S, Tei C (2002) Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation. Circ J 66:913–916

    Article  PubMed  Google Scholar 

  8. Takahashi Y, Izumi C, Miyake M, Imanaka M, Kuroda M, Nishimura S, Yoshikawa Y, Amano M, Imamura S, Onishi N, Tamaki Y, Enomoto S, Tamura T, Kondo H, Kaitani K, Nakagawa Y (2017) Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease. Int J Cardiol 243:251–257

    Article  PubMed  Google Scholar 

  9. Ortiz-Leon XA, Posada-Martinez EL, Trejo-Paredes MC, Ivey-Miranda JB, Pereira J, Crandall I, Dasilva P, Bouman E, Brooks A, Gerardi C, Ugonabo I, Chen W, Houle H, Akar JG, Lin BA, McNamara RL, Lombo-Lievano B, Arias-Godinez JA, Sugeng L (2020) Understanding tricuspid valve remodelling in atrial fibrillation using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 21:747–755

    Article  PubMed  Google Scholar 

  10. Spinka G, Bartko PE, Heitzinger G, Prausmüller S, Pavo N, Frey MK, Arfsten H, Genger M, Hengstenberg C, Hülsmann M, Goliasch G (2021) Natural Course of Nonsevere Secondary Tricuspid Regurgitation. J Am Soc Echocardiogr 34:13–19

    Article  PubMed  Google Scholar 

  11. Mutlak D, Khalil J, Lessick J, Kehat I, Agmon Y, Aronson D (2020) Risk Factors for the Development of Functional Tricuspid Regurgitation and Their Population-Attributable Fractions. JACC Cardiovasc Imaging 13:1643–1651

    Article  PubMed  Google Scholar 

  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2014) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg 12:1495–1499

    Article  Google Scholar 

  13. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol 63:e57–e185

    Article  PubMed  Google Scholar 

  14. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A, Kikuchi K, Haneda M, Hashimoto S, Ura N, Ito S, Sato H, Watanabe T, Ando Y, Kusano E, Nojima Y, Saitoh C, Shiigai T, Maeda Y, Suzuki H, Watanabe Y, Mitarai T, Hasegawa H, Fujita T, Hosoya T, Matsumoto K, Fujita T, Sanaka T, Kanda E, Sasaki S, Nakano T, Akizawa T, Honda H, Inoue Y, Yoshimura A, Fukunaga M, Tsuji H, Ohashi Y, Nakajima H, Uchida S, Yamada A, Umemura S, Yanagi M, Yamakawa H, Kimura K, Nishi S (2009) Revised Equations for Estimated GFR From Serum Creatinine in Japan. Am J Kidney Dis 53:982–992

    Article  CAS  PubMed  Google Scholar 

  15. Lang RM, Badano LP, Victor MA, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Retzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1-39.e14

    Article  PubMed  Google Scholar 

  16. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF III, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD, Smiseth O, Klein A (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Hear Journal-Cardiovascular Imaging 17:1321–1360

    Article  Google Scholar 

  17. Austin PC, White IR, Lee DS, van Buuren S (2021) Missing Data in Clinical Research: A Tutorial on Multiple Imputation. Can J Cardiol 37:1322–1331

    Article  PubMed  Google Scholar 

  18. Mutlak D, Aronson D, Lessick J, Reisner SA, Dabbah S, Agmon Y (2009) Functional tricuspid regurgitation in patients with pulmonary hypertension: Is pulmonary artery pressure the only determinant of regurgitation severity? Chest 135:115–121

    Article  PubMed  Google Scholar 

  19. Shiran A, Sagie A (2009) Tricuspid Regurgitation in Mitral Valve Disease. Incidence, Prognostic Implications, Mechanism, and Management. J Am Coll Cardiol 53:401–408

    Article  PubMed  Google Scholar 

  20. Gorter TM, Hoendermis ES, van Veldhuisen DJ, Voors AA, Lam CSP, Geelhoed B, Willems TP, van Melle JP (2016) Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail 18:1472–1487

    Article  PubMed  Google Scholar 

  21. Medvedofsky D, Aronson D, Gomberg-Maitland M, Thomeas V, Rich S, Spencer K, Mor-Avi V, Addetia K, Lang RM, Shiran A (2017) Tricuspid regurgitation progression and regression in pulmonary arterial hypertension: Implications for right ventricular and tricuspid valve apparatus geometry and patients outcome. Eur Heart J Cardiovasc Imaging 18:86–94

    Article  PubMed  Google Scholar 

  22. Topilsky Y, Khanna A, Le TT, Park S, Michelena H, Suri R, Mahoney DW, Enriquez-Sarano M (2012) Clinical context and mechanism of functional tricuspid regurgitation in patients with and without pulmonary hypertension. Circ Cardiovasc Imaging 5:314–323

    Article  PubMed  Google Scholar 

  23. Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel RJ, Shiota T (2017) Functional Tricuspid Regurgitation Caused by Chronic Atrial Fibrillation: A Real-Time 3-Dimensional Transesophageal Echocardiography Study. Circ Cardiovasc Imaging 10:e004897

    Article  PubMed  Google Scholar 

  24. Zhao SX, Soltanzad N, Swaminathan A, Ogden WD, Schiller NB (2017) Frequency and Associated Clinical Features of Functional Tricuspid Regurgitation in Patients With Chronic Atrial Fibrillation. Am J Cardiol 119:1371–1377

    Article  PubMed  Google Scholar 

  25. Park JH, Shin SH, Lee MJ, Lee MD, Shim HI, Yoon J, Oh S, Kim DH, Park SD, Kwon SW, Woo SI, Park KS, Kwan J (2015) Clinical and echocardiographic factors affecting tricuspid regurgitation severity in the patients with lone atrial fibrillation. J Cardiovasc Ultrasound 23:136–142

    Article  PubMed  PubMed Central  Google Scholar 

  26. Colombo T, Russo C, Ciliberto GR, Lanfranconi M, Bruschi G, Agati S, Vitali E (2001) Tricuspid regurgitation secondary to mitral valve disease: Tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg 9:369–377

    Article  CAS  PubMed  Google Scholar 

  27. Shi KH, Xuan HY, Zhang F, Xu SS, Wu JX, Cao W, Gong WH, Zhao XD (2012) Evolution of tricuspid regurgitation after mitral valve surgery for patients with moderate-or-less functional tricuspid regurgitation. Heart Surg Forum 15:E121–E126

    Article  PubMed  Google Scholar 

  28. Nishimura S, Izumi C, Yamasaki S, Obayashi Y, Kuroda M, Amano M, Harita T, Nishiuchi S, Sakamoto J, Tamaki Y, Enomoto S, Miyake M, Kondo H, Tamura T, Nakagawa Y (2020) Impact of right ventricular function on development of significant tricuspid regurgitation in patients with chronic atrial fibrillation. J Cardiol 76:431–437

    Article  PubMed  Google Scholar 

  29. Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ (2002) A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 347:1834–1840

    Article  PubMed  Google Scholar 

  30. Itakura K, Hidaka T, Nakano Y, Utsunomiya H, Kinoshita M, Susawa H, Harada Y, Izumi K, Kihara Y (2020) Successful catheter ablation of persistent atrial fibrillation is associated with improvement in functional tricuspid regurgitation and right heart reverse remodeling. Heart Vessels 35:842–851

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We are grateful to the sonographers (Mai Hisano, Suguru Hisano, Daisuke Wake, Yoshiko Kawachi, Shizuko Nishio, and Rieko Higaki) for obtaining echocardiographic images and Editage (www.editage.jp) for English language editing.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, 795-8505, Japan

    Masaki Kinoshita, Makoto Saito, Tatsuro Tasaka, Hirohiko Nakagawa, Kaori Fujimoto, Sumiko Sato & Takumi Sumimoto

  2. Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime, Japan

    Katsuji Inoue, Kazuhisa Nishimura, Shuntaro Ikeda & Osamu Yamaguchi

Authors
  1. Masaki Kinoshita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Makoto Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katsuji Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsuro Tasaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hirohiko Nakagawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kaori Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sumiko Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kazuhisa Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shuntaro Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takumi Sumimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Osamu Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [MK], [MS], [TT], [HN], [KF], [SS, and [TS]. The first draft of the manuscript was written by [MK], [MS], and [KI]. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Masaki Kinoshita.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest. All authors declare no relationships with industry relevant to this paper.

Ethical approval

Institutional Review Board Approval was obtained.

Informed consent

Informed consent was obtained as an opt-out form on the Kitaishikai Hospital website.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kinoshita, M., Saito, M., Inoue, K. et al. Incremental value of tricuspid annular enlargement to progressive tricuspid regurgitation in patients with longstanding persistent atrial fibrillation. Heart Vessels (2024). https://doi.org/10.1007/s00380-024-02405-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00380-024-02405-6

Keywords

Search

Navigation