Changes Of Right Heart Echocardiographic In Functional Tricuspid Regurgitation With Atrial Fibrillation And Its Mechanism

Background:Atrial fibrillation refers to the disappearance of normal and regular systolic and diastolic activity in the atria,replaced by a fast disordered tremor wave,which is one of the common arrhythmias.Tricuspid regurgitation is usually divided into organic and functional.Organic tricuspid regurgitation is usually caused by congenital or acquired lesions of the valve leading to regurgitation caused by changes in the structure of the tricuspid valve.Functional tricuspid regurgitation refers to the reversal of the valve's dysfunction due to the enlargement of the atrial ventricle and dysfunction in the absence of organic lesions in the tricuspid valve.Atrial fibrillation has been considered as one of the risk factors for tricuspid regurgitation.Functional tricuspid regurgitation has often been ignored in the past because it is thought to be associated with other pathological problems such as left heart valve disease and can be improved after correcting the primary problem.A number of recent studies have shown that despite proper repair of the left valve,tricuspid regurgitation may still occur,and functional tricuspid regurgitation may be an important factor in adverse clinical outcomes.This study used cross-sectional retrospective analysis design principles to observe the clinical data and cardiac ultrasound parameters of different degrees of tricuspid regurgitation in patients with atrial fibrillation,correlation analysis was performed to explore which clinical data and echocardiographic parameters were associated with functional tricuspid regurgitation in patients with atrial fibrillation.The results of this study are helpful for clinical pre-judgment of patients,providing clinical data and reference value for improving the prognosis of patients.Method:Retrospective analysis of 88 patients diagnosed with atrial fibrillation by electrocardiogram at the First Affiliated Hospital of Nanchang University from March2017 to February 2018.All patients were divided into three groups according to the degree of tricuspid regurgitation: 44 patients in the mild group,22 patients in the moderate group,and 22 patients in the severe group.Exclusion criteria:(1)valvular disease or valve surgery(2)right ventricular dysfunction(3)LVEF < 50%(4)congenital heart disease(5)primary pulmonary hypertension(6)diffuse pulmonary parenchymal disease(7)Various connective tissue diseases(8)atrial fibrillation but not with tricuspid regurgitation.Clinical data and echocardiographic parameters of patients who met the inclusion criteria were collected and grouped according to the degree of valve regurgitation.Correlation analysis was performed between clinical parameters and cardiac hyperparameters between different groups.Among the 88 patients with atrial fibrillation,the differences in clinical data parameters between the mild,moderate,and severe groups were significant.First,the patient's age was different between mild,moderate,and severe groups(P < 0.05).And as the age increases,the degree of tricuspid regurgitation is heavier.Secondly,the period of atrial fibrillation was also different among the groups,and the severe group showed a longer period of atrial fibrillation(P<0.05).The clinical data,such as past history and gender,were not statistically significant among the groups.In the echocardiographic parameters,the left atrial diameter was statistically significant(P<0.05),and the right ventricular outflow tract was statistically different between the groups(P<0.05).The more severe the tricuspid regurgitation was,the more large right ventricular outflow tract;right atrial area was different between groups(P<0.05),the larger right atrial area showed more severe tricuspid regurgitation;right ventricular spherical index was statistically different between groups(P <0.05),the larger the right ventricular spherical index shows the more severe tricuspid regurgitation.There was a significant difference in right atrial pressure between the different groups(P<0.05).The higher the right atrial pressure,the more severe the tricuspid regurgitation;There were also significant differences in tricuspid annulus between different groups(P<0.05),The larger the tricuspid annulus,the more severe the tricuspid regurgitation.The p-values of the echocardiographic parameters such as left ventricular end-diastolic diameter and ejection fraction were all greater than 0.05.It was considered that there was no significant difference between the parameters of left ventricular end-diastolic diameter and ejection fraction in mild,moderate and severe.From the results of the correlation test,the severity of the tricuspid regurgitation was significantly correlated with age,the period of atrial fibrillation,right atrial area,spherical index,right atrial pressure,and tricuspid annulus,and was positively correlated.Conclusion:Right ventricular outflow tract diameter,right atrial area,right ventricular spherical index,right atrial pressure,and tricuspid annulus are closely related to the degree of tricuspid regurgitation in patients with atrial fibrillation,and the severity of the tricuspid regurgitation is positively correlated with age,the period of atrial fibrillation,right atrial area,spherical index,right atrial pressure,and tricuspid annulus.The ability to improve these echocardiographic indicators is essential to prevent patients with right heart failure and improve patient outcomes.