Mitral and tricuspid regurgitation in patients with atrial fibrillation

Abstract Background Atrial fibrillation (AF) leads to atrial and annular remodelling, which can impair leaflet coaptation, causing secondary atrioventricular valve regurgitation (AVVR). However, data on the development of new atrial functional AVVR are limited. Purpose This study aims to determine the incidence and predictors of atrial functional mitral (MR) and tricuspid regurgitation (TR) in AF patients without structural heart disease. Methods 1,055 patients with recent onset AF and no structural heart disease at diagnosis were analysed. Patients were retrospectively followed over time to identify the development of moderate or severe MR and TR. Results Of the 1,055 patients, 175 (16.6%) developed significant AVVR over a median follow-up of 3.9 ± 2.1 years. Non-paroxysmal AF was the strongest predictor (HR 43.82, 95% CI: 10.73-179.13; p0.001), followed by female sex (HR 2.37, 95% CI: 1.61-3.49; p0.001) and older age (HR 1.05, 95% CI: 1.02-1.08; p0.001). TR developed earlier and in a higher proportion of patients compared to MR during follow-up. Patients with significant AVVR faced double the risk of mortality or heart failure (HF) admission during follow-up (HR 2.27, 95% CI: 1.62-3.18; p0.001). Conclusion The incidence of significant atrial functional MR and TR in AF patients is substantial, especially among women and those with non-paroxysmal AF. Moreover, significant AVVR was linked to a twofold increase in mortality and heart failure admissions, highlighting its prognostic importance in AF management.Baseline characteristics Incidence of AVVR