Backround: Tricuspid regurgitation (TR) is classified as either primary TR (dysfunctional valve leaflets), secondary (functional) TR or a combination of both. As functional TR may be caused or worsened by atrial arrhythmias, restoration of sinus rhythm (SR) may reduce TR. This study is designed to collect prospective data of tricuspid function after SR restoration.
Methods: Patients with atrial arrhythmias (Atrial fibrillation (AF) and atrial flutter (Aflut)) were screened for tricuspid valve insufficiency using echocardiography prior to cardioversion or radiofrequency ablation. Patients with at least moderate TR were included. Clinical, ECG and echocardiographic follow up was scheduled three months after restoration of SR.
Results: 23 patients (59.1% (13/22) female, 76.8 ± 8.2 years old) were included. At follow up, 86.4% (19/22) were still in SR. Echocardiographic follow up showed significant reduction in TR (see figure 1), accompanied by right atrial volume and right ventricular inflow tract size reduction (see table 1). In patients with recurrent AF/Aflut TR reduction was not observed.
Conclusion: This prospective study shows significant improvement of TR after restoring SR. This suggests SR restoration should be discussed as part of TR therapy.
Figure 1 (TR severity baseline and follow-up, shown in %)
|
Parameter |
Baseline |
Follow-up |
p-value |
|
|
HR |
mean ± sd |
105.7±24.1 |
68.4±9.5 |
p<0.0001 |
|
LVEF |
mean ± sd |
45±14.3 |
53.4±9.6 |
p=0.003 |
|
TAPSE |
mean ± sd |
19.2±5.3 |
21.9±5.9 |
p=0.65 |
|
PAP |
mean ± sd |
41.3±11.2 |
37.4±10.7 |
p=0.14 |
|
LAV |
mean ± sd |
97.5±26 |
87.6±28 |
p=0.02 |
|
RAV |
mean ± sd |
80±28.1 |
62.1±28.9 |
p=0.001 |
|
TR Severity |
||||
|
mild |
n (%) |
0 (0) |
12 (54.5) |
|
|
moderate |
n (%) |
16 (27.3) |
9 (41) |
|
|
severe |
n (%) |
6 (72.7) |
1 (4.5) |
|
|
RVIT |
mean ± sd |
44.2±9.2 |
40.6±7.1 |
p=0.03 |
|
Tricuspid Valve - Vena Contracta |
mean ± sd |
6.2±2.5 |
3.4±2 |
p=0.006 |
|
MR Severity |
||||
|
mild |
n (%) |
9 (40.9) |
16 (72.7) |
|
|
moderate |
n (%) |
8 (36.4) |
4 (18.2) |
|
|
severe |
n (%) |
5(22.7) |
2 (9.1) |
|
|
Mitral Valve-Annulus |
mean ± sd |
40.4±3.2 |
39.8±5 |
p=0.65 |
|
Mitral Valve -Vena Contracta |
mean ± sd |
4.1±2.1 |
2.6±1.8 |
p=0.001 |
|
Intervention |
|
|
|
|
|
Ablation |
n (%) |
8 (36.4) |
|
|
|
Cardioversion |
n (%) |
14 (63.6) |
|
|
Table 1: Echocardiographic parameters before and after SR restoration. HR=heart rate; LVEF=left ventricular ejection fraction; TAPSE=tricuspid annular plane systolic excursion; PAP=pulmonary artery pressure; LAV=left atrial volume; RAV=right atrial volume; MR=Mitral regurgitation; RVIT=right ventricular inflow tract
https://dgk.org/kongress_programme/ht2021/P770.htm