The Prevalence and Prognostic Significance of Functional Mitral Regurgitation and Tricuspid Regurgitation Occurring Despite Preserved Left Ventricular Ejection Fraction in Patients with Atrial Fibrillation
Yukio Abe1, Kanako Akamatsu1, Kazato Ito1, Yoshiki Matsumura1, Takahiko Naruko1, Yosuke Takahashi2, Toshihiko Shibata2, Minoru Yoshiyama2.
1Osaka City General Hospital, Osaka, Japan, 2Osaka City University Medical School, Osaka, Japan.
Objectives: To investigate the prevalence and prognostic significance of functional mitral regurgitation (MR) and tricuspid regurgitation (TR) occurring despite preserved left ventricular ejection fraction (LVEF) in patients with atrial fibrillation (AF). Methods: We retrospectively studied the consecutive 5,226 cases who underwent transthoracic echocardiography in our laboratory. AF was seen in 556 (11%) patients, and we selected 172 patients with AF and LVEF > 50% after excluding patients with other underlying heart diseases. Results: Out of the 172 patients with AF and LVEF > 50%, significant (moderate or severe) functional MR and TR were seen in 14 (8%) and 26 (15%), respectively (MR vs. TR, p=0.011). Nine (5%) had both significant MR and TR. Significant MR was less frequently seen in patients with the AF duration < 10 years than patients with the AF duration > 10 years (4% vs. 27%, p=0.0053). In contrast, there was no significant difference in the prevalence of significant TR between patients with the AF duration < 10 years and patients with the AF duration > 10 years (12% vs. 27%). During the follow-up period of 2.2 ± 1.5 years, 20 (12%) patients met the composite end point defined as cardiac death, admission due to heart failure, or mitral and tricuspid valve surgery. In a Cox proportional hazard ratio analysis, both the MR grading and the TR grading could predict the end point independently of each other. The Kaplan-Meyer analysis showed the patients with both significant functional MR and TR had the poor prognoses with the event free rate of 13% at the mean follow-up period. Conclusions: Functional MR is less frequently seen in patients with AF and preserved LVEF than functional TR is. However, the concomitance of such MR and TR carries poor prognoses in AF patients with preserved LVEF, and may have to be treated more intensively.
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