Progression of atrioventricular valve regurgitation in patients with and without atrial fibrillation
M Koechlin, R Paladini, S Aeschbacher, C Meyer-Zuern, I Strebel, M Coslovsky, M Liskij, R Kerler, P Krisai, L Bonati, D Conen, F Mahfoud, S Osswald, M Kuehne, B KaufmannAbstract
Background
Mitral regurgitation (MR) and tricuspid regurgitation (TR) are common valvular disorders that can worsen over time, potentially leading to heart failure. Atrial fibrillation (AF) is known to affect atrial structure and hemodynamics and may contribute to the progression of MR or TR. However, longitudinal data quantifying progression rates in patients with versus without AF are limited.
Purpose
To assess the progression rates of MR and TR in patients with versus without AF.
Methods
A total of 412 patients with and without AF from the Swiss-AF and BEAT-AF cohorts who underwent at least two transthoracic echocardiography (TTE) examinations at a Swiss tertiary care hospital between 2015 and 2025 were included. MR and TR were graded at both timepoints using standard guidelines (trivial, mild, moderate, and severe). The primary endpoint was any progression, defined as any increase in grade between the first and last available TTE. Clinically relevant progression additionally required at least moderate severity at the second TTE. Progression rates were calculated as the incidence of progression per person-years of follow-up. Multivariable logistic regression analyses were performed to examine the association between AF and progression of MR or TR. In addition, predicted probabilities of progression were calculated for each baseline grade.
Results
Median age at first TTE was 74 years (IQR 69-81), 27% were female. The incidence of any MR progression was 7.3 vs. 15.0 and of clinically relevant progression 3.3 vs. 3.9 per 100 person-years (AF vs. non-AF patients). The corresponding incidence rates for TR progression were 9.9 vs. 8.9 and 5.2 vs. 2.1 per 100 person-years, respectively. In multivariable analyses, AF was independently associated with a higher likelihood of both any TR progression (OR 3.79, 95% CI 1.83–8.27, p < 0.001) and clinically relevant TR progression (OR 3.97, 95% CI 1.25–17.82, p = 0.035) compared to no AF. In contrast, no significant associations were observed for MR progression, whether defined as any progression (OR 1.05, 95% CI 0.52–2.18, p = 0.885) or as clinically relevant progression (OR 1.38, 95% CI 0.54–4.05, p = 0.529).
Conclusion
In this analysis, atrial fibrillation was associated with higher rates of progression of tricuspid regurgitation severity. However, AF was not associated with higher rates of progression of mitral regurgitation.Graphical Abstract