Association of Right Ventricular-Pulmonary Arterial Coupling and Progression of Tricuspid Regurgitation in Patients With Atrial Fibrillation

Background Tricuspid regurgitation (TR) severity is associated with poor prognosis in patients with atrial fibrillation (AF). Recently, right ventricular-pulmonary arterial (RV-PA) coupling has been shown to be related to clinical outcomes in patients with TR. However, data on the relationship of RV-PA coupling to the progression of significant TR are limited. This study aimed to investigate whether RV-PA coupling affects the progression of significant TR in patients with AF. Methods Among 664 patients with AF who underwent follow-up echocardiography at least 6 months after the initial assessment, 484 consecutive patients with AF (mean age 68 +/- 12 years, 38% women) with insignificant TR were included. RV-PA coupling was assessed by the ratio of RV 4-chamber strain measured through speckle tracking echocardiography to pulmonary artery systolic pressure (PASP). Results Over a mean 3.6 +/- 2.7 years of follow-up, 46 (9.5%) patients have progressed to significant TR, at least a moderate degree. Patients who progressed to significant TR were older, more likely to be women, had higher E/e' and PASP, lower RV4CSL and RV 4-chamber strain /PASP compared with patients without TR progression. RV-PA coupling, reflected by RV 4-chamber strain/PASP, was independently associated with the progression of TR even after adjusting for age, sex, and E/e' (P <0.001). It remained significant for predicting TR progression even after further adjustment for PASP or RV strain (all P <0.001). Conclusions In patients with AF, RV-PA coupling was independently associated with the progression of TR, suggesting that it may be helpful in monitoring this population.