Abstract：
OBJECTIVE: Incidence and types of secondary tricuspid regurgitation (TR) are not well defined in atrial fibrillation (AFib) and sinus rhythm (SR). Atrial secondary TR (A-STR) is associated with pre-existing AFib; however, close to 50% of patients with A-STR do not have AFib. The aim of this study was to assess incidence, types, and outcomes of ≥ moderate TR in AFib vs. SR.
METHODS: Adults with and without new-onset AFib without structural heart disease or ≥ moderate TR at baseline were followed for the development of ≥ moderate TR. Tricuspid regurgitation types were pacemaker, left-sided valve disease, left ventricular (LV) dysfunction, pulmonary hypertension (PH), isolated ventricular, and A-STR.
RESULTS: Among 1359 patients with AFib and 20 438 in SR, 109 and 378 patients developed ≥ moderate TR, respectively. The individual types of TR occurred more frequently in AFib related to the higher pacemaker implantation rates (1.12 vs. 0.19 per 100 person-years, P < .001), larger right atrial size (median 78 vs. 53 mL, P < .001), and higher pulmonary pressures (median 30 vs. 28 mmHg, P < .001). The most common TR types irrespective of rhythm were LV dysfunction-TR and A-STR. Among patients in SR, those with A-STR were older, predominantly women with more diastolic abnormalities and higher pulmonary pressures. All types of secondary TR were associated with all-cause mortality, highest in PH-TR and LV dysfunction-TR.
CONCLUSIONS: New-onset AFib vs. SR conferred a higher risk of the individual TR types related to sequelae of AFib and higher pacemaker implantation rates, although the distribution of TR types was similar. Secondary TR was universally associated with increased mortality.
METHODS: Adults with and without new-onset AFib without structural heart disease or ≥ moderate TR at baseline were followed for the development of ≥ moderate TR. Tricuspid regurgitation types were pacemaker, left-sided valve disease, left ventricular (LV) dysfunction, pulmonary hypertension (PH), isolated ventricular, and A-STR.
RESULTS: Among 1359 patients with AFib and 20 438 in SR, 109 and 378 patients developed ≥ moderate TR, respectively. The individual types of TR occurred more frequently in AFib related to the higher pacemaker implantation rates (1.12 vs. 0.19 per 100 person-years, P < .001), larger right atrial size (median 78 vs. 53 mL, P < .001), and higher pulmonary pressures (median 30 vs. 28 mmHg, P < .001). The most common TR types irrespective of rhythm were LV dysfunction-TR and A-STR. Among patients in SR, those with A-STR were older, predominantly women with more diastolic abnormalities and higher pulmonary pressures. All types of secondary TR were associated with all-cause mortality, highest in PH-TR and LV dysfunction-TR.
CONCLUSIONS: New-onset AFib vs. SR conferred a higher risk of the individual TR types related to sequelae of AFib and higher pacemaker implantation rates, although the distribution of TR types was similar. Secondary TR was universally associated with increased mortality.
摘要：
目的：继发性三尖瓣反流（TR）的发生率和类型在心房颤动（AFib）和窦性心律（SR）中并不明确。心房次级TR(A-STR)与先前存在的AFib相关；然而，接近50%的A-STR患者没有AFib。这项研究的目的是评估发病率，类型,AFib中≥中度TR的结果与SR.
方法：基线时有和没有新发AFib且无结构性心脏病或≥中度TR的成人随访≥中度TR的发展。三尖瓣返流类型为起搏器，左侧瓣膜疾病，左心室（LV）功能障碍，肺动脉高压(PH),孤立的心室，A-STR.
结果：在1359例AFib患者和20438例SR患者中，109例和378例患者出现≥中度TR，分别。在AFib中，与较高的起搏器植入率相关的单个类型的TR发生频率更高（1.12vs.每100人年0.19，P<.001),右心房大小较大(中位数78vs.53mL,P<.001),和更高的肺压(中位数30vs.28mmHg,P<.001)。与节律无关的最常见的TR类型是LV功能障碍-TR和A-STR。在SR患者中，那些有A-STR的人年纪更大，主要是女性有更多的舒张异常和更高的肺压。所有类型的继发性TR都与全因死亡率相关，PH-TR和LV功能障碍-TR最高。
结论：新发AFib与SR赋予了与AFib后遗症相关的个体TR类型的更高风险和更高的起搏器植入率，尽管TR类型的分布相似。继发性TR普遍与死亡率增加相关。
方法：基线时有和没有新发AFib且无结构性心脏病或≥中度TR的成人随访≥中度TR的发展。三尖瓣返流类型为起搏器，左侧瓣膜疾病，左心室（LV）功能障碍，肺动脉高压(PH),孤立的心室，A-STR.
结果：在1359例AFib患者和20438例SR患者中，109例和378例患者出现≥中度TR，分别。在AFib中，与较高的起搏器植入率相关的单个类型的TR发生频率更高（1.12vs.每100人年0.19，P<.001),右心房大小较大(中位数78vs.53mL,P<.001),和更高的肺压(中位数30vs.28mmHg,P<.001)。与节律无关的最常见的TR类型是LV功能障碍-TR和A-STR。在SR患者中，那些有A-STR的人年纪更大，主要是女性有更多的舒张异常和更高的肺压。所有类型的继发性TR都与全因死亡率相关，PH-TR和LV功能障碍-TR最高。
结论：新发AFib与SR赋予了与AFib后遗症相关的个体TR类型的更高风险和更高的起搏器植入率，尽管TR类型的分布相似。继发性TR普遍与死亡率增加相关。
