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Publications

Journal Article Epublish

PubMed: 42452658 DOI: 10.3390/jcm15135198

Combined Atrial Functional Mitral and Tricuspid Regurgitation in Atrial Fibrillation: Prevalence, Associated Factors, and Three-Dimensional Valve Remodeling.

J Clin Med 15(13)

Authors: Andrei-Alexandru Nour, Diana-Ruxandra Hădăreanu, Despina-Manuela Toader, Călin-Dinu Hădăreanu, Maria-Livia Iovănescu, Anca Mihu-Marinescu, Georgică-Costinel Târtea, Ionuț Donoiu, Edme-Roxana Mustafa, Oana Munteanu-Mirea, Răzvan-Ilie Radu, Octavian Istrătoaie, Cristina Florescu

Affiliations

  • Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St. 200349 Craiova, Romania. Department of Cardiology, Filantropia Clinical Hospital, 28 Sararilor St. 200516 Craiova, Romania.
  • Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St. 200349 Craiova, Romania.
  • Department of Cardiology, Clinical Emergency County Hospital of Craiova, 1 Tabaci St. 200642 Craiova, Romania.
  • Doctoral School, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St. 200349 Craiova, Romania.
  • Department of Cardiovascular Surgery, Clinical Emergency County Hospital of Craiova, 1 Tabaci St. 200642 Craiova, Romania.
  • Department of Cardiology, Filantropia Clinical Hospital, 28 Sararilor St. 200516 Craiova, Romania. Department of Cardiology, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St. 200349 Craiova, Romania.
  • Department of Cardiology, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bld. 050474 Bucharest, Romania.
  • Department of Interventional Cardiology, Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 258 Fundeni St. 022328 Bucharest, Romania.
  • Department of Cardiology, Filantropia Clinical Hospital, 28 Sararilor St. 200516 Craiova, Romania.

Abstract

Background/Objectives: Atrial fibrillation (AF) may cause functional mitral regurgitation (MR) and tricuspid regurgitation (TR) through atrial remodeling and annular dilation. However, the prevalence and structural characteristics of combined MR/TR in AF are not well defined. We aimed to determine the prevalence, clinical profile, and factors associated with combined clinically significant MR and TR in AF patients. Methods: In this prospective observational study (REMO-FIB), 175 consecutive AF patients underwent comprehensive transesophageal echocardiography with three-dimensional mitral valve analysis. After excluding organic MR and significant aortic valve disease, 125 patients were analyzed. Patients were classified into four groups according to the presence of moderate/severe MR and/or TR. Multivariable logistic regression evaluated factors associated with the combined phenotype. Results: Among 125 patients, 53 (42.4%) had no significant MR/TR, 33 (26.4%) had isolated MR, 11 (8.8%) had isolated TR, and 28 (22.4%) had combined MR/TR. Compared with patients without regurgitation, those with combined MR/TR had higher symptom burden (EHRA class, p = 0.036), more heart failure (92.9% vs. 67.9%, p = 0.048), larger left (47.0 vs. 42.0 mm, p = 0.002) and right atria (42.0 vs. 38.0 mm, p < 0.001), higher pulmonary artery pressure (40.0 vs. 28.0 mmHg, p = 0.004), and lower left ventricular ejection fraction (47.5% vs. 55.0%, p = 0.006). Three-dimensional analysis showed larger mitral annular perimeter (129.0 vs. 121.0 mm, p = 0.009), greater annular area (12.7 vs. 11.1 cm 2, p = 0.014), longer anterior leaflet length (26.5 vs. 24.0 mm, p < 0.001), and greater tenting area (2.1 vs. 1.4 cm 2, p = 0.002). Factors independently associated with the combined phenotype were female sex (OR 4.60, p = 0.015), lower ejection fraction (OR 0.47 per SD, p = 0.005), and larger right atrial diameter (OR 1.85 per SD, p = 0.037). Model discrimination was good (AUC 0.81). Conclusions: Combined moderate/severe MR and TR affects over one-fifth of AF patients without organic valve disease and is associated with advanced biatrial remodeling, adverse symptoms, and heart failure. Comprehensive assessment of both atrioventricular valves should be considered in AF.

MeSH

Atrial Remodeling, Heart Failure, Heart, Phenotype, Atrial Fibrillation, Prevalence, Tricuspid Valve Insufficiency, Mitral Valve Insufficiency