Prediction of improvement in mitral and tricuspid regurgitation in patients with atrial fibrillation after restoration of sinus rhythm

https://doi.org/10.1007/s00392-025-02625-4

Felix Schwarz (Berlin)1, S. Biewener (Berlin)1, A. Sannino (Berlin)1, M. Kasner (Berlin)1, M. Reinthaler (Berlin)1, U. Landmesser (Berlin)1, G. Hindricks (Berlin)2, M. Huemer (Berlin)1, P. Attanasio (Berlin)1

1Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin Berlin, Deutschland; 2Charité - Universitätsmedizin Berlin CC11: Med. Klinik m. S. Kardiologie und Angiologie Berlin, Deutschland

 

Introduction

Atrial fibrillation (AF) has been identified to cause both functional Mitral- (MR) and Tricuspid regurgitation (TR), yet as causes of MR and TR are often multifactorial, identification of patients the benefit from sinus rhythm (SR) restoration can be challenging. The prospective Berlin FRAVAF (Functional Regurgitation of Atrioventricular Valves and Atrial Fibrillation) registry included patients with AF and newly diagnosed at least moderate secondary MR or TR undergoing cardioversion or AF ablation. Aim of this study was to investigate and identify potential predictors of MR and TR regression at follow-up. 

Methods and Results

Eighty patients (46% male, average age 73.7 (68.0-81.0) years) with persistent atrial fibrillation and newly diagnosed at least moderate MR or TR who underwent either cardioversion or catheter ablation were included. Clinical and echocardiographic follow up was performed after 12 months. Baseline characteristics of patients with MR or TR improvement of at least one grade were compared to patients with lack thereof. 

No significant differences in baseline characteristics were observed between patients with and patients without MR improvement at follow up (Table 1). Conversely, patients with TR improvement had better right ventricular function at baseline (TAPSE 18 (16-25) vs. 15.5 (13-16) mm, p=0.014) and lower vena contracta 5.3 (4.6-7.5) vs. 5.8 (4.8-7) mm, p=0.045 (Table 2)).
 
Conclusion

Although none of the selected parameters was able to predict MR regression after SR restoration, better baseline right ventricular function and lower vena contracta were associated with TR improvement at follow up. These findings highlight the potential role of TR phenotypes in response to different treatment approaches. 

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