Najib Mohammad Q, Vinales Karyne L, Vittala Satya S, Challa Suresh, Lee Howard R, Chaliki Hari P
Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona 85259, USA.
Echocardiography. 2012 Feb;29(2):140-6. doi: 10.1111/j.1540-8175.2011.01565.x. Epub 2011 Nov 8.
Atrial fibrillation (AF) may be a risk factor for severe functional tricuspid valve regurgitation (FTR). We aimed to determine the predictors of severe FTR in patients with AF.
From our echocardiographic laboratory database, we searched for and reviewed the medical records of consecutive patients with severe FTR and AF seen at Mayo Clinic in Arizona from 2002 through 2009. Our search identified 42 patients who met all inclusion criteria. These patients (cases) with severe FTR and AF were compared with 38 patients (controls) with AF who had no greater than mild tricuspid regurgitation. Case patients with severe FTR were older than controls (mean, 81 years vs. 76 years; P < 0.001) and more frequently had chronic AF (69% vs 26%; P < 0.001). Mean right atrial volume (86 mL/m(2) vs 46 mL/m(2) ; P < 0.001), right ventricular volume (42 mL ± 33 mL vs 22 mL ±8 mL; P < 0.001) and tricuspid annular diameter (3.6 cm vs 3.0 cm; P < 0.001) were larger in cases than in controls. Patients with severe FTR also had a higher prevalence of right-sided heart failure (69% vs 16%; P < 0.001). After adjusting for age and gender, right atrial and right ventricular volumes were independent predictors for the development of severe FTR in patients with AF (odds ratio, 1.7 [95% CI, 1.3-2.8] for every 10 mL/m(2) increase in right atrial volume; P = 0.0002 and odds ratio, 3.1 [95% CI, 1.5-8.9] for every 10 mL increase in right ventricular volume; P = 0.0002).
Severe FTR occurs in older patients with chronic AF as a result of marked right atrial and right ventricular dilatation; and enlargement of the tricuspid annulus in the absence of pulmonary hypertension. More importantly, severe FTR leads to increased prevalence of right-sided heart failure underscoring the nonbenign nature of chronic AF.
心房颤动（AF）可能是严重功能性三尖瓣反流（FTR）的一个危险因素。我们旨在确定AF患者中严重FTR的预测因素。
从我们的超声心动图实验室数据库中，我们检索并回顾了2002年至2009年在亚利桑那州梅奥诊所就诊的连续性严重FTR和AF患者的病历。我们的检索确定了42例符合所有纳入标准的患者。将这些患有严重FTR和AF的患者（病例组）与38例AF但三尖瓣反流不超过轻度的患者（对照组）进行比较。严重FTR的病例组患者比对照组年龄更大（平均81岁对76岁；P<0.001），且慢性AF的发生率更高（69%对26%；P<0.001）。病例组的平均右心房容积（86 mL/m²对46 mL/m²；P<0.001）、右心室容积（42 mL±33 mL对22 mL±8 mL；P<0.001）和三尖瓣环直径（3.6 cm对3.0 cm；P<0.001）均大于对照组。严重FTR患者右侧心力衰竭的患病率也更高（69%对16%；P<0.001）。在调整年龄和性别后，右心房和右心室容积是AF患者发生严重FTR的独立预测因素（右心房容积每增加10 mL/m²，比值比为1.7[95%CI，1.3 - 2.8]；P = 0.0002；右心室容积每增加10 mL，比值比为3.1[95%CI，1.5 - 8.9]；P = 0.0002）。
严重FTR发生于患有慢性AF的老年患者，是由于明显的右心房和右心室扩张，以及在无肺动脉高压情况下三尖瓣环扩大所致。更重要的是，严重FTR导致右侧心力衰竭患病率增加，凸显了慢性AF的非良性本质。
