{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:39:53Z","timestamp":1792366793707,"version":"4.4.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"National Institute for Health and Care Research (NIHR) Biomedical Research Centre at Barts"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Echo Res Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Atrial functional tricuspid regurgitation (AFTR) is increasingly recognized as a result of atrial remodelling in patients with atrial fibrillation (AF). However, prognostic predictors in this population remain incompletely defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate echocardiographic characteristics and identify predictors of all-cause mortality in patients with AFTR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively studied consecutive patients with AF who underwent transthoracic echocardiography between 2017 and 2025. Inclusion required significant right atrial remodelling, defined as a right atrial area\u2009&gt;\u200925 cm\n                      <jats:sup>2<\/jats:sup>\n                      . Patients with at least moderate functional tricuspid regurgitation comprised the AFTR cohort, while patients with mild\/trivial\/no tricuspid regurgitation served as controls. Patients with primary valvular disease, cardiomyopathy, congenital heart disease, device-related valve disease, RV dilatation, or more than mild RV systolic dysfunction were excluded. Cox proportional hazards regression was performed to identify predictors of mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 152 patients were included, comprising 120 patients with AFTR and 32 controls. Compared with controls, patients with AFTR demonstrated larger atrial dimensions, higher right-sided hemodynamic-burden, impaired RV longitudinal strain, and reduced reservoir RA strain. During a median follow-up of 6.3 years, 53 deaths (45%) occurred among patients with AFTR. In univariable Cox analysis, age (HR 1.02, 95% CI 1.00-1.04;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.016), TR Vmax (HR 1.59, 95% CI 1.07\u20132.35;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020), and lower reservoir RA strain (HR 0.90, 95% CI 0.84\u20130.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) were associated with mortality. In multivariable analysis, reservoir RA strain remained independently associated with mortality (adjusted HR 0.88, 95% CI 0.81\u20130.95;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>AFTR is characterized by marked biatrial remodelling and impaired right atrial function. Reduced RA reservoir strain was independently associated with mortality, supporting a potential role for RA deformation imaging in risk stratification in AFTR.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s44156-026-00140-4","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:02:04Z","timestamp":1792364524000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants of outcome in atrial functional tricuspid regurgitation"],"prefix":"10.1186","volume":"13","author":[{"given":"Jawza","family":"Aldakhil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kush","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sveeta","family":"Badiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen E.","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Lloyd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev","family":"Bhattacharyya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"140_CR1","doi-asserted-by":"publisher","unstructured":"Sagris M, Vardas EP, Theofilis P, Antonopoulos AS, Oikonomou E, Tousoulis D. Atrial fibrillation: pathogenesis, predisposing factors, and genetics. 2021; Available from: https:\/\/doi.org\/10.3390\/ijms23010006","DOI":"10.3390\/ijms23010006"},{"key":"140_CR2","doi-asserted-by":"crossref","unstructured":"Abe Y, Akamatsu K, Ito K, Matsumura Y, Shimeno K, Naruko T, et al. Prevalence and prognostic significance of functional mitral and tricuspid regurgitation despite preserved left ventricular ejection fraction in atrial fibrillation patients. Circ J [Internet]. 2018 [cited 2023 Apr 5];82(5):1451\u20138. Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/29553091\/","DOI":"10.1253\/circj.CJ-17-1334"},{"key":"140_CR3","doi-asserted-by":"crossref","unstructured":"Florescu DR, Muraru D, Volpato V, Gavazzoni M, Caravita S, Tomaselli M, et al. Atrial functional tricuspid regurgitation as a distinct pathophysiological and clinical entity: no idiopathic tricuspid regurgitation anymore. J Clin Med [Internet]. 2022 Jan 1 [cited 2026 Feb 26];11(2). Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/35054074\/","DOI":"10.3390\/jcm11020382"},{"key":"140_CR4","doi-asserted-by":"crossref","unstructured":"Utsunomiya H, Itabashi Y, Mihara H, Berdejo J, Kobayashi S, Siegel R,J et al. Functional tricuspid regurgitation caused by chronic atrial fibrillation: a real-time 3-dimensional transesophageal echocardiography study. Circ Cardiovasc Imaging [Internet]. 2017 Jan 1 [cited 2026 Feb 26];10(1). Available from: https:\/\/pubmed.ncbi.nlm.nih.gov\/28073806\/","DOI":"10.1161\/CIRCIMAGING.116.004897"},{"key":"140_CR5","doi-asserted-by":"crossref","unstructured":"Mohyeldin M, Abdelghafar A, Allu S, Shrivastava S, Mustafa A, Mohamed FO, et al. Atrial functional tricuspid regurgitation: a comprehensive review of pathophysiology, diagnosis, and management strategies. Rev Cardiovasc Med [Internet]. 2024 Dec 1 [cited 2026 Mar 11];25(12). 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Available from: https:\/\/doi.org\/10.1093\/ehjcvp\/pvaf040","DOI":"10.1093\/ehjcvp\/pvaf040"}],"container-title":["Echo Research &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44156-026-00140-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44156-026-00140-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44156-026-00140-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T23:02:05Z","timestamp":1792364525000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44156-026-00140-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["140"],"URL":"https:\/\/doi.org\/10.1186\/s44156-026-00140-4","relation":{},"ISSN":["2055-0464"],"issn-type":[{"value":"2055-0464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"25 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval was obtained for this study and the need for informed consent was waived due to the retrospective, observational nature of this study (North West \u2013 Greater Manchester South Research Ethics Committee; reference number: 21\/NW\/0182).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Consultancy, Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada (SEP). KPP has an unrestricted research grant from Edwards Lifesciences and Abbott Vascular.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"38"}}