Characteristics and outcome of patients with atrial secondary tricuspid regurgitation in sinus rhythm

Abstract Introduction Atrial secondary tricuspid regurgitation (A-STR), a distinct subtype of secondary TR evolving with predominant right atrial (RA) remodelling, has been mainly associated with long-standing atrial fibrillation (AF). However, A-STR has been reported also in the absence of documented AF, but the characteristics and outcome of these patients remain poorly understood. Purpose To evaluate clinical and echocardiographic characteristics of patients with A-STR without concomitant AF as compared to matched controls. Methods In this multicentre study, 113 patients with significant (≥moderate) A-STR without a history of AF were matched 1:1 to 113 controls without structural heart disease based on age, sex, and comorbidities, such as diabetes and arterial hypertension. The study endpoint was a composite of all-cause mortality and heart failure hospitalization. Patients undergoing tricuspid valve intervention were censored at the time of the intervention. Results A total of 226 patients were included (age 68±12years, 66% female). By study design, baseline demographics and comorbidities were similar between the A-STR and control groups.However, A-STR patients had significantly higher NYHA functional class (NYHA II-IV: A-STR :48% vs. control: 9%,p