# Predictors of significant tricuspid regurgitation in atrial fibrillation: a meta-analysis

## TL;DR

This study identifies factors that may increase the risk of significant tricuspid regurgitation in patients with atrial fibrillation.

## Contribution

The study provides a meta-analysis of predictors for significant tricuspid regurgitation in atrial fibrillation patients using a global database.

## Key findings

- Female sex, persistent atrial fibrillation, and age are significant predictors of tricuspid regurgitation.
- Heart failure and chronic lung disease also increase the risk of significant tricuspid regurgitation.
- Echocardiography parameters like right ventricle fractional area change and pulmonary arterial pressure are associated with tricuspid regurgitation.

## Abstract

Significant tricuspid regurgitation (TR) in atrial fibrillation (AF) patients is becoming a global issue, as it can lead to progressive right ventricular enlargement and heart failure, thereby increasing morbidity and mortality. This study aimed to evaluate potential predictors of significant TR in AF patients using open databases.

PubMed, EMBASE, the Cochrane Library, and Web of Science were searched for relevant studies from inception to September 2023. Using STATA 14.0 statistical software, hazard ratios (HRs) were calculated for data synthesis. The potential predictors included clinical characteristics, echocardiography parameters, and prior comorbidities. Evidence certainty was evaluated based on the GRADE system.

In total, 12 studies involving almost 16,000 patients were included in this review. Female sex (HR = 2.14; 95% CI: 1.84–2.49; I2 = 0.0%; p = 0.430), persistent atrial fibrillation (HR = 2.99; 95% CI: 2.47–3.61; I2 = 0.0%; p = 0.896), left ventricular ejection fraction [standard mean difference (SMD) = −0.16; 95% CI:−0.30 to −0.03; I2 = 69.8%; p < 0.000], age (HR = 1.07; 95% CI: 1.04–1.09; I2 = 72.3%; p = 0.013), heart failure (HR = 1.86; 95% CI: 1.45–2.39; I2 = 9.0%; p = 0.348), age ≥65 years (HR = 2.30; 95% CI: 1.63–3.25; I2 = 55.1%; p = 0.108), chronic lung disease (HR = 1.33; 95% CI: 1.02–1.74; I2 = 0.0%; p = 0.882), right ventricle fractional area change (SMD = 0.18; 95% CI: 0.01–0.36; I2 = 0.0%; p = 0.440), systolic pulmonary arterial pressure (SMD = 0.97; 95% CI: 0.76–1.19; I2 = 41.5%; p = 0.181), and proper ventricular systolic pressure (SMD = 1.07; 95% CI: 0.54–1.59; I2 = 92.4%; p < 0.000) may negatively influence significant TR.

This meta-analysis identified a potential negative influence of several clinical characteristics, echocardiography parameters, and previous comorbidities on significant TR. However, due to the low level of certainty of evidence, our analysis can only provide some guidance to practitioners and researchers. Caution is advised, and further validation is needed.