Elsevier

The American Journal of Cardiology

Volume 162, 1 January 2022, Pages 129-135
The American Journal of Cardiology

Functional Tricuspid Regurgitation and Right Atrial Remodeling in Heart Failure With Preserved Ejection Fraction

https://doi.org/10.1016/j.amjcard.2021.09.021Get rights and content

Tricuspid regurgitation (TR) is common in patients with heart failure with preserved ejection fraction (HFpEF), but it has not been well characterized. We hypothesized that right atrial (RA) remodeling would be associated with TR in HFpEF, forming a type of atrial functional TR (AFTR). Echocardiography was performed in 328 patients with HFpEF. TR severity was defined using a guidelines-based approach. Ventricular functional TR was defined as the presence of right ventricular (RV) systolic pressure >50 mm Hg or RV dilation, and the remaining patients were classified as having AFTR if they had RA dilation or tricuspid annular enlargement. RA dilation was common (78%) in the significant TR group (more than mild), exceeding the prevalence of RV dilation (32%), and RA dilation was correlated with tricuspid annular diameter and TR vena contracta width (r = 0.67 and r = 0.70, both p <0.0001). Despite the absence of RV dilation and pulmonary hypertension, 38% of patients with significant TR had AFTR. Patients with AFTR and those with ventricular functional TR displayed higher heart failure hospitalization rates than those with nonsignificant TR (adjusted hazard ratios, 2.45 and 4.31; 95% confidence interval 1.12 to 5.35 and 2.44 to 7.62, p = 0.02 and p <0.0001, respectively). In conclusion, TR in HFpEF is related to RA remodeling, and the presence of AFTR was associated with poor clinical outcomes. The current data highlight the importance of RA remodeling in the pathophysiology of TR in HFpEF.

Section snippets

Disclosures

The authors have no conflicts of interest to declare.

References (31)

Cited by (0)

Dr. Obokata is supported by research grants from the Fukuda Foundation for Medical Technology, Tokyo, Japan; the Mochida Memorial Foundation for Medical and Pharmaceutical Research, Tokyo, Japan; Nippon Shinyaku, Kyoto, Japan; Takeda Science Foundation, Osaka, Japan; the Japanese Circulation Society, Tokyo, Japan; and the Japanese College of Cardiology, Tokyo, Japan.Dr. Borlaug is supported by R01 HL128526; ***.

View full text