The impact of severe tricuspid regurgitation on quality of life among patients with atrial fibrillation

Abstract Introduction Atrial fibrillation (AF) is a widespread arrhythmia that influences the quality of life (QOL) and tricuspid regurgitation (TR) frequently occurs alongside AF in these patients. Aim The goal of the study was to assess the quality of life in patients with AF and severe TR. Material and methods In this prospective study AF patients admitted consecutively to a tertiary clinical hospital, between January 2021 and July 2022, were included irrespective of the cause of hospitalization. QOL was measured using the validated AFEQT questionnaire with the cutoff value set by the mean value. The severe TR at echocardiography was defined according to current european guidelines. Patients with AF were divided into four categories: patients with paroxysmal, persistent, long-standing persistent, and permanent AF. Right ventricular dysfunction was defined using the tricuspid annular plane systolic excursion (TAPSE) less than 17mm, peak systolic velocity of the tricuspid annulus (s'RV) less than 10cm/s, with cutoff values in accordance with the EACVI-ASE guidelines. High arrhythmic burden was determined by the number of AF episodes (more than 5 episodes per month) and by the type of AF (long-standing persistent or permanent AF). Results 117 patients with AF and TR, 57.26% women, mean age 71±10 years , were included in the study. 41.03% patients had a poor QOL and were significantly older (p 0.002). Severe TR was present in 13.68% AF patients. Mean AFEQT score was significantly lower in patients with severe TR (42.88±12.68 vs 35.45±18.08, p 0.02). Right atrial volume index (HR 6.72, 95%CI 1.63-27.63, p 0.008) and systolic pulmonary artery pressure (HR 1.1, 95%CI 1.03-1.20, p 0.001) were independent predictors for severe TR. AFEQT score was directly correlated with left ventricle ejection fraction (r 0.508, p 0.001), TAPSE (r 0.456, p 0.001), S’RV (r 0.486, p 0.001) and inversely correlated with NTproBNP values (r -0.570, p 0.001), age (r -0.462, p0.001), CHA2DS2-VASC score (r -0.493, p 0.001), right atrial volume index (r -0.405, p 0.001) and left atrial volume index (r -0.428, p 0.001) In multivariable analysis, after adjusting for age and sex, severe TR was an independent predictor of poor QOL (HR 3.83, 95%CI 1.09-13.46, p 0.035), alongside high arrhythmic burden (HR 3.06, 95%CI 1.15-8.14, p 0.025), CHA2DS2-VASC score (HR 1.37, 95%CI 1.07-1.75, p 0.01), increased NTproBNP (HR 1.83, 95%CI 1.10-3.05, p 0.020), non-paroxysmal AF (HR 4.01, 95%CI 1.34-11.90, p 0.012) and right ventricle dysfunction (HR 6.41, 95% CI 2.66-15.42, p<0.001) Conclusion In patients with atrial fibrillation the association of severe tricuspid regurgitation was an independent predictor for reduced quality of life.