(P113) PROGRESSION OF TRICUSPID REGURGITATION AND CLINICAL OUTCOMES IN PATIENTS WITH LONGSTANDING PERSISTENT ATRIAL FIBRILLATION

Background:

Background: Atrial fibrillation (AF) is a global epidemic associated with progressive tricuspid regurgitation (TR) related to annular dilatation. Data on the progression of TR severity and associated outcomes are sparse. In this study, we examined the relationship between progression of TR and clinical outcomes in patients with longstanding persistent AF.

METHODS AND RESULTS: In this cohort study, consecutive patients with longstanding persistent AF who underwent serial transthoracic echocardiography (TTE) between 2005 and 2010, and had ≥2 TTEs at least 1 year apart during the study period, were identified from the database of a tertiary care hospital. Those with previous tricuspid surgery, greater than moderate mitral regurgitation at baseline, or congenital heart disease were excluded. Baseline and the most recent TTEs during the study period were reviewed to assess TR severity and to measure echocardiographic parameters of the right heart. Clinical events (mortality, hospital visit for heart failure/arrhythmias, and tricuspid repair) were determined from a review of medical records. Among the 215 patients (133 male, age at baseline study = 71±11 years) included in the study, 91 (42%) had worsening of TR on follow-up TTEs. The mean magnitude of increase in TR severity was nearly 1 grade (0.8±0.5). Patients with worsening of TR by at least 1 grade at follow-up were not significantly different from the rest of the study population in terms of echocardiographic parameters at baseline, but follow-up TTEs
demonstrated significantly larger right atrial and ventricular dimensions, worse right ventricular systolic function, and higher pulmonary artery systolic pressure in those with worsening of TR. During a mean follow-up of 11±4 years, event-free survival was 35.1% for patients with worsening of TR by at least 1 grade, compared with 52.8% for those with more minor changes in TR (p = 0.019). Similar results were observed for overall survival (40.5% vs 59.6%, p = 0.013).

Conclusion: For patients with longstanding persistent AF, worsening of TR on serial TTE is common. Progression of TR by at least one grade is associated with right heart remodeling, worsening of hemodynamics, and increased cardiovascular events and mortality.