Tricuspid regurgitation: a hidden risk factor for atrial fibrillation related stroke?

Yong Soo Kim; Han-Gil Jeong; In-Chang Hwang; Beom Joon Kim; Joon-Myung Kwon; Hee-Joon Bae; Moon-Ku Han

doi:10.3389/fcvm.2023.1135069

Tricuspid regurgitation: a hidden risk factor for atrial fibrillation related stroke?

Front Cardiovasc Med. 2023 Jul 18:10:1135069. doi: 10.3389/fcvm.2023.1135069. eCollection 2023.

Authors

Yong Soo Kim^{1

2}, Han-Gil Jeong³, In-Chang Hwang⁴, Beom Joon Kim¹, Joon-Myung Kwon⁵, Hee-Joon Bae¹, Moon-Ku Han¹

Affiliations

¹ Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
² Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea.
³ Division of Neurocritical Care, Department Of Neurosurgery and Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁴ Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
⁵ Department of Critical Care and Emergency Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea.

Abstract

Background and purpose: Tricuspid regurgitation (TR) is a common but overlooked valvular disease, and its association with the etiologic subtypes of ischemic stroke is unclear. We explored the relationship between TR and atrial fibrillation (AF) in patients with acute ischemic stroke.

Methods: This retrospective analysis of ongoing stroke registry assessed 6,886 consecutive acute ischemic stroke patients who underwent transthoracic echocardiography during their in-hospital care. Multivariable logistic regression models adjusted for age, sex, stroke characteristics, and echocardiographic indices were used to investigate the association between TR and total AF, and newly diagnosed AF during hospitalization and a 1-year follow-up period, respectively.

Results: TR was present in 877 (12.7%) patients (mild, 9.9%; moderate, 2.4%; severe, 0.5%). AF was identified in 24.1% (medical history, 11.1%; first detected in the emergency room, 6.6%; newly diagnosed after admission, 6.4%). TR was associated with AF [adjusted odds ratio (aOR) 4.87 (95% confidence interval (CI), 2.63-9.03)], compared with no/trivial TR. The association between TR and AF was consistent regardless of severity (aOR [95% CI], 4.57 [2.63-7.94] for mild and 7.05 [2.57-19.31] for moderate-to-severe TR) or subtype of TR (5.44 [2.91-10.14] for isolated and 3.81 [2.00-7.28] for non-isolated TR). Among the AF-naïve patients at admission, TR was associated with newly diagnosed AF during hospitalization and a 1-year follow-up period (aOR [95% CI], 2.68 [1.81-3.97]).

Conclusions: TR is associated with AF in acute ischemic stroke patients regardless of severity and subtypes of TR. TR is also associated with newly diagnosed AF after stroke.

Keywords: atrial cardiopathy; atrial fibrillation; ischemic stroke; stroke subtype; tricuspid regurgitation.

Grants and funding

This work was supported by the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (grant number NRF-2020M3E5D9079768).