Tricuspid regurgitation ups risk of death in patients with atrial fibrillation

Moderate or greater tricuspid valve regurgitation (TR) has developed over time in some patients with atrial fibrillation (AF), reports a recent study.

“Incident significant TR and incident isolated significant TR portend a worse survival in patients with AF,” the researchers said.

Adult patients with new-onset AF were identified using a population-based record linkage system. Those with evidence of moderate or greater tricuspid valve disease, left-sided valve disease, pulmonary hypertension, prior cardiac surgery, impaired left ventricular systolic/diastolic function at baseline were excluded. Eligible patients (n=691) were followed over time to identify those who would develop moderate or greater TR over time and to assess its effect of subsequent survival.

Overall, 232 (33.6 percent) developed moderate or greater TR, among whom 73 (10.6 percent) had isolated TR with no significant underlying structural heart disease. The incidence rates of any moderate or greater TR and of isolated TR were 3.9 and 1.3 cases per 100 person-years, respectively.

Factors associated with a higher risk of developing TR were permanent/persistent AF and female sex, while rhythm control correlated with a reduced risk.

During a median follow-up of 13.3 years, development of any moderate or greater TR (hazard ratio, 2.92, 95 percent confidence interval [CI], 2.29‒3.73; p<0.001) and isolated significant TR (HR, 1.51, 95 percent CI, 1.03‒2.22; p=0.03) showed a significant association with an adjusted increased risk of subsequent mortality.

“AF is considered a risk factor for isolated TR in the absence of other known aetiologies,” the researchers noted.