Department of Cardiology Keio University School of Medicine Tokyo Japan.
Department of Cardiology Tokyo Medical Center Tokyo Japan.
J Am Heart Assoc. 2022 Apr 19;11(8):e022713. doi: 10.1161/JAHA.121.022713. Epub 2022 Apr 6.
Background Atrial fibrillation and heart failure (HF) possess mutual risk factors and share a common pathophysiological pathway. Tricuspid regurgitation (TR) is a known predictor of adverse events in patients with HF. However, its implications on patients with atrial fibrillation in its early stage remain unknown. Methods and Results Data of 2211 patients without previous HF diagnosis were extracted from a prospective, multicenter registry of newly diagnosed patients with atrial fibrillation. TR was categorized as absent, mild, moderate, and severe based on the American Society of Echocardiography recommendations. The primary outcome was time to first hospitalization for HF after enrollment. The Atrial Fibrillation Effects on Quality-of-Life scores were compared. Overall, 1107 patients (50.1%) had TR (42.3%, 7.2%, and 0.6% for mild, moderate, and severe, respectively). During follow-up (median 730 [interquartile range, 366-731] days), 44 patients (2.0%) experienced HF hospitalization, and the incidence increased with severity of TR (<0.001). TR was an associated predictor of the primary outcome (hazard ratio [HR]: 2.51, =0.050; HR: 6.19, =0.008; for moderate and severe TR versus no TR). Changes in AFEQT overall score were negatively related to TR severity (8.7±17.5 versus 8.5±17.0 versus 3.1±17.5 versus 1.4±11.8, absent versus mild versus moderate versus severe TR, respectively), although it was not an independent predictor after adjustments. Conclusions TR severity at atrial fibrillation diagnosis was an associated predictor of subsequent hospitalization for HF, which may warrant the need for a more intensive follow-up and HF-related management.
心房颤动（房颤）和心力衰竭（HF）具有共同的危险因素，且具有共同的病理生理途径。三尖瓣反流（TR）是 HF 患者不良事件的已知预测因子。然而，其在早期房颤患者中的意义尚不清楚。
从一项前瞻性、多中心新诊断房颤患者注册研究中提取了 2211 例无既往 HF 诊断的患者数据。根据美国超声心动图学会的建议，将 TR 分为无、轻度、中度和重度。主要结局是登记后首次因 HF 住院的时间。比较了房颤对生活质量评分的影响。总的来说，1107 例患者（50.1%）存在 TR（分别为轻度、中度和重度 42.3%、7.2%和 0.6%）。在随访期间（中位数 730[四分位距 366-731]天），44 例患者（2.0%）经历了 HF 住院，且随着 TR 严重程度的增加，发生率也随之增加（<0.001）。TR 是主要结局的相关预测因子（风险比[HR]：2.51，=0.050；HR：6.19，=0.008；中度和重度 TR 与无 TR 相比）。AFEQT 总评分的变化与 TR 严重程度呈负相关（8.7±17.5 与 8.5±17.0 与 3.1±17.5 与 1.4±11.8，无 TR 与轻度 TR 与中度 TR 与重度 TR 相比），但在调整后不是独立的预测因子。
房颤诊断时的 TR 严重程度与随后 HF 住院的发生相关，这可能需要更密切的随访和 HF 相关管理。
