Department of Cardiology, University of Medicine and Pharmacy of Craiova, Strada Petru Rareș 2, Craiova 200349, Romania.
Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital Piazzale Brescia 20, 20149 Milan, Italy.
Eur Heart J Cardiovasc Imaging. 2022 Jun 21;23(7):930-940. doi: 10.1093/ehjci/jeab211.
Atrial functional tricuspid regurgitation (A-FTR) is a recently defined phenotype of functional tricuspid regurgitation (FTR) associated with persistent/permanent atrial fibrillation. Differently from the classical ventricular form of FTR (V-FTR), patients with A-FTR might present with severely dilated right atrium and tricuspid annulus (TA), and with preserved right ventricular (RV) size and systolic function. However, the geometry and function of the right ventricle, right atrium, and TA in patients with A-FTR and V-FTR remain to be systematically evaluated. Accordingly, we sought to: (i) study the geometry and function of the right ventricle, right atrium, and TA in A-FTR by two- and three-dimensional transthoracic echocardiography; and (ii) compare them with those found in V-FTR.
We prospectively analysed 113 (44 men, age 68 ± 18 years) FTR patients (A-FTR = 55 and V-FTR = 58) that were compared to two groups of age- and sex-matched controls to develop the respective Z-scores. Severity of FTR was similar in A-FTR and V-FTR patients. Z-scores of RV size were significantly larger, and those of RV function were significantly lower in V-FTR than in A-FTR (P < 0.001 for all). The right atrium was significantly enlarged in both A-FTR and V-FTR compared to controls (P < 0.001, Z-scores > 2), with similar right atrial (RA) maximum volume (RAVmax) between A-FTR and V-FTR (P = 0.2). Whereas, the RA minimum volumes (RAVmin) were significantly larger in A-FTR than in V-FTR (P = 0.001).
Despite similar degrees of FTR and RAVmax size, A-FTR patients show larger RAVmin and smaller TA areas than V-FTR patients. Conversely, V-FTR patients show dilated, more elliptic and dysfunctional right ventricle than A-FTR patients.
三尖瓣功能性反流（A-FTR）是一种与持续性/永久性心房颤动相关的功能性三尖瓣反流（FTR）的新定义表型。与经典的 FTR 心室形式（V-FTR）不同，A-FTR 患者可能表现为右心房和三尖瓣环（TA）严重扩张，且右心室（RV）大小和收缩功能正常。然而，A-FTR 和 V-FTR 患者的右心室、右心房和 TA 的几何形状和功能仍需系统评估。因此，我们试图：（i）通过二维和三维经胸超声心动图研究 A-FTR 患者的右心室、右心房和 TA 的几何形状和功能；（ii）并将其与 V-FTR 患者进行比较。
我们前瞻性分析了 113 例（44 名男性，年龄 68±18 岁）FTR 患者（A-FTR=55 例，V-FTR=58 例），并将其与两组年龄和性别匹配的对照组进行比较，以建立各自的 Z 评分。A-FTR 和 V-FTR 患者的 FTR 严重程度相似。V-FTR 患者的 RV 大小 Z 评分显著更大，而 RV 功能 Z 评分显著更低（所有 P<0.001）。与对照组相比，A-FTR 和 V-FTR 患者的右心房均显著增大（所有 P<0.001，Z 评分>2），A-FTR 和 V-FTR 之间的右心房最大容积（RAVmax）相似（P=0.2）。然而，A-FTR 患者的右心房最小容积（RAVmin）明显大于 V-FTR 患者（P=0.001）。
尽管 FTR 和 RAVmax 大小相似，但 A-FTR 患者的 RAVmin 较大，TA 面积较小，而 V-FTR 患者的右心室扩张、更呈椭圆形和功能障碍更大。
