Left atrial pressure and significant tricuspid regurgitation in persistent atrial fibrillation

Atrial fibrillation (AF) is a well-established contributing factor to isolated tricuspid regurgitation (TR), with elevated left atrial pressure (LAP) playing a crucial role in disease progression and patient outcomes. We investigated the relationship between LAP and TR in patients with AF.

We enrolled individuals diagnosed with AF who underwent LA appendage closure at two centers in China, between January 2015 and December 2023. Participants were classified into two groups based on TR severity: those with moderate-to-severe TR and those with no significant TR groups. Baseline characteristics, imaging findings, and follow-up data were analyzed.

A total of 189 participants were included, of whom 60 had moderate-to-severe TR. Compared to the no-TR group, the moderate-to-severe TR group was older (74.22 ± 9.71 years vs. 69.37 ± 8.04 years, p < 0.001), had a longer history of persistent AF (7.41 ± 7.18 years vs. 2.08 ± 2.26 years, p < 0.001), and exhibited lower hemoglobin and hematocrit levels. In addition, patients in the moderate-to-significant TR group were more likely to have mitral regurgitation, larger LA diameters, higher LA systolic pressure (LASP), higher LA diastolic pressure, higher mean LA pressure, and pulmonary hypertension (all p < 0.001). Elevated LAP was strongly associated with right heart remodeling and significant TR in patients with persistent AF. Regression analysis identified LASP, mitral regurgitation, and AF duration as independent predictors of significant TR (all p < 0.01).

Early identification of LAP elevation and right heart remodeling may guide targeted interventions to prevent TR progression and improve patient outcomes. Furthermore, the recognition of LASP and AF duration as predictors of TR and LA dysfunction emphasizes the need for thorough clinical assessments in treatment planning.