Right atrial functional remodeling for early risk stratification of tricuspid regurgitation progression in atrial fibrillation.

Tricuspid regurgitation (TR) is related to a poor prognosis in atrial fibrillation (AF). Although right atrial (RA) structural remodeling contributes to TR progression, the impact of RA functional remodeling on the progression of TR remains unclear. We investigated whether RA function influences TR progression in AF. Among 664 AF patients with baseline and follow-up echocardiography, 484 (mean 68 ± 12 years, 38% female) with insignificant (mild or less) TR at baseline were included. Patients with prior cardiac surgery, cardiac implantable electronic devices, significant (at least moderate) valvular diseases, LVEF < 50%, suboptimal images for strain analysis, or follow-up echocardiography < 6 months were excluded. A cut-off value for RA reservoir strain was 12.6%, as determined by ROC analysis. Over a mean 3.6 ± 2.7 years, 46 (9.5%) patients developed significant TR. Patients with RA reservoir strain < 12.6% were older, had more persistent AF, higher E/e' and pulmonary artery systolic pressure (PASP), larger left atrium (LA) and RA, and lower LA strain. On multivariable regression, RA reservoir strain < 12.6% was independently associated with TR progression after adjustment for age, sex, and RA volume (p = 0.027), and remained significant after further adjustment for E/e' or PASP. Impaired RA reservoir strain was independently associated with TR progression in AF patients with initially insignificant TR, suggesting that RA functional assessment may provide additional information complementary to RA structural remodeling and help identify patients at higher risk of TR progression.