Impact of atrial fibrillation on tricuspid and mitral annular dilatation and valvular regurgitation

Abstract

To investigate the effects of atrial fibrillation (AF) on the mitral and tricuspid valves, the corresponding annular dilatation and valvular regurgitation were compared with 2-dimensional and Doppler echocardiography in 31 consecutive patients with lone AF and 28 normal controls. Mid-systolic mitral and tricuspid annular areas were measured from 2 diameters in 2 orthogonal apical echocardiograms. Percent (%) mitral regurgitant (MR) or tricuspid regurgitant (TR) jet area to the left or right atrial area was evaluated and % MR or TR jet area >20% was considered moderate or significant. Both the mitral and tricuspid annular areas in patients with lone AF were significantly larger compared with the controls (mitral: 9.5±1.2 vs 6.6±0.9cm2, lone AF vs control, p<0.01) (tricuspid: 12.0±2.0 vs 7.5±0.9cm2, p<0.01). The % increase in the annular area relative to the mean normal value was significantly greater in the tricuspid valve (44±18 vs 60±28%, p<0.01). Moderate or severe MR was not observed and the incidence of moderate or severe valve regurgitation (% jet area >20%) was significantly higher in the tricuspid valve (0/31 vs 11/31, MR vs TR, p<0.01) in patients with lone AF. The % TR jet area showed significant correlation with tricuspid annular area (r2=0.65, p<0.001). Lone AF is associated with annular dilatation of both mitral and tricuspid valves, but the annular dilatation and valvular regurgitation are significantly greater in the tricuspid valve.