Abstract 17707: The Association of Atrial Fibrillation With Tricuspid Regurgitation Progression is Age-Dependent

Background: The prevalence of significant Tricuspid Regurgitation (TR) in individuals with Atrial Fibrillation (AF) is notably high. This analysis aimed to investigate the association of AF with TR progression after more than 10 years, and to ascertain influencing factors of this association.

Methods: Electrocardiographic reports linked to clinical data (N=52,389; 2007-2012) were reviewed. Only patients with apparently normal left heart and with ECG and echocardiographic reports at baseline and at after a minimum of 5 years were included. The primary outcome was the occurrence of new significant TR in a follow-up echocardiogram.

Results: The final study included 5,691 patients with a median age of 62 (IQR: 53-70), 845 (14%) of whom had baseline AF. During a median follow-up period of 12 years, 279 (5%) patients developed significant TR. Patients with AF were 6 times more likely to develop significant TR in a univariate model (95% CI 5.3-6.8,p <.001). A multivariate model demonstrated that AF, older age, female sex and pulmonary pressures were all associated with increased risk of TR progression (p<.001 for all). The association of AF with future TR was age-dependent such that among patients older than 60, AF was associated with 3.6-fold increased risk compared with 4.5-fold increased risk among younger adults (p for interaction=0.01). During follow up, 1,197 (21%) patients died. Kaplan-Meier analysis revealed increased mortality risk with significant TR and/or AF (log-rank p<.001 for both). Multiarvariate Cox analysis demonstrated that compared to significant TR patients without AF, the combination of TR and AF was associated with a significant 42% higher risk of death during follow up (p=0.04).

Conclusions: The association of AF with TR progression after more than 10 years of follow up is more prominent among younger patients. This emphasize the importance of TR screening in AF patients and implementing interventions to mitigate TR progression and improve outcomes.