Determinants of outcome in atrial functional tricuspid regurgitation.
11 affiliations
- 1Heart Valve Clinic & Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
- 2NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London, EC1M 6BQ, UK.
- 3College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- 4King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
- 5Institute of Cardiovascular Sciences, UCL, London, UK.
- 6Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7BE, UK.
- 7Cleveland Clinic London, London, UK.
- 8Heart Valve Clinic & Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. [email protected].
- 9NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London, EC1M 6BQ, UK. [email protected].
- 10Institute of Cardiovascular Sciences, UCL, London, UK. [email protected].
- 11Cleveland Clinic London, London, UK. [email protected].
Abstract
Background
Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a result of atrial remodelling in patients with atrial fibrillation (AF). However, prognostic predictors in this population remain incompletely defined.Objectives
To evaluate echocardiographic characteristics and identify predictors of all-cause mortality in patients with AFTR.Methods
We retrospectively studied consecutive patients with AF who underwent transthoracic echocardiography between 2017 and 2025. Inclusion required significant right atrial remodelling, defined as a right atrial area > 25 cm². Patients with at least moderate functional tricuspid regurgitation comprised the AFTR cohort, while patients with mild/trivial/no tricuspid regurgitation served as controls. Patients with primary valvular disease, cardiomyopathy, congenital heart disease, device-related valve disease, RV dilatation, or more than mild RV systolic dysfunction were excluded. Cox proportional hazards regression was performed to identify predictors of mortality.Results
A total of 152 patients were included, comprising 120 patients with AFTR and 32 controls. Compared with controls, patients with AFTR demonstrated larger atrial dimensions, higher right-sided hemodynamic-burden, impaired RV longitudinal strain, and reduced reservoir RA strain. During a median follow-up of 6.3 years, 53 deaths (45%) occurred among patients with AFTR. In univariable Cox analysis, age (HR 1.02, 95% CI 1.00-1.04; p = 0.016), TR Vmax (HR 1.59, 95% CI 1.07-2.35; p = 0.020), and lower reservoir RA strain (HR 0.90, 95% CI 0.84-0.96; p = 0.003) were associated with mortality. In multivariable analysis, reservoir RA strain remained independently associated with mortality (adjusted HR 0.88, 95% CI 0.81-0.95; p < 0.001).Conclusion
AFTR is characterized by marked biatrial remodelling and impaired right atrial function. Reduced RA reservoir strain was independently associated with mortality, supporting a potential role for RA deformation imaging in risk stratification in AFTR.
Related
- Impact of atrial fibrillation catheter ablation o'n tricuspid regurgitation severity: a systematic review and meta-analysis.
- Risk of Atrial Fibrillation Recurrence After Modified Cox-Maze IV Surgery: Comparing Atrial Functional Mitral Regurgitation and Rheumatic Mitral Regurgitation
- Determinants of Disproportionality in Functional Mitral Regurgitation ― Importance of Mitral Valve Morphology ―
- Clinical Relevance of Atriogenic Tethering in Atrial Functional Mitral Regurgitation
- Atrial functional mitral regurgitation – current concepts in mechanisms, imaging, and management
BibTeX
@article{aldakhil2026determinants,
title = {{Determinants of outcome in atrial functional tricuspid regurgitation.}},
author = {Jawza Aldakhil and Kush Patel and Sveeta Badiani and Steffen E Petersen and Guy Lloyd and Sanjeev Bhattacharyya},
journal = {Echo research and practice},
year = {2026},
month = oct,
doi = {10.1186/s44156-026-00140-4},
url = {https://europepmc.org/article/MED/42894198},
note = {CC BY},
}
RIS
TY - JOUR
TI - Determinants of outcome in atrial functional tricuspid regurgitation.
AU - Jawza Aldakhil
AU - Kush Patel
AU - Sveeta Badiani
AU - Steffen E Petersen
AU - Guy Lloyd
AU - Sanjeev Bhattacharyya
PY - 2026
DA - 2026/10/19
JO - Echo research and practice
DO - 10.1186/s44156-026-00140-4
UR - https://europepmc.org/article/MED/42894198
AB - Background Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a result of atrial remodelling in patients with atrial fibrillation (AF). However, prognostic predictors in this population remain incompletely defined.Objectives To evaluate echocardiographic characteristics and identify predictors of all-cause mortality in patients with AFTR.Methods We retrospectively studied consecutive patients with AF who underwent transthoracic echocardiography between 2017 and 2025. Inclusion required significant right atrial remodelling, defined as a right atrial area > 25 cm². Patients with at least moderate functional tricuspid regurgitation comprised the AFTR cohort, while patients with mild/trivial/no tricuspid regurgitation served as controls. Patients with primary valvular disease, cardiomyopathy, congenital heart disease, device-related valve disease, RV dilatation, or more than mild RV systolic dysfunction were excluded. Cox proportional hazards regression was performed to identify predictors of mortality.Results A total of 152 patients were included, comprising 120 patients with AFTR and 32 controls. Compared with controls, patients with AFTR demonstrated larger atrial dimensions, higher right-sided hemodynamic-burden, impaired RV longitudinal strain, and reduced reservoir RA strain. During a median follow-up of 6.3 years, 53 deaths (45%) occurred among patients with AFTR. In univariable Cox analysis, age (HR 1.02, 95% CI 1.00-1.04; p = 0.016), TR Vmax (HR 1.59, 95% CI 1.07-2.35; p = 0.020), and lower reservoir RA strain (HR 0.90, 95% CI 0.84-0.96; p = 0.003) were associated with mortality. In multivariable analysis, reservoir RA strain remained independently associated with mortality (adjusted HR 0.88, 95% CI 0.81-0.95; p < 0.001).Conclusion AFTR is characterized by marked biatrial remodelling and impaired right atrial function. Reduced RA reservoir strain was independently associated with mortality, supporting a potential role for RA deformation imaging in risk stratification in AFTR.
SN - 2055-0464
ER -