Atrial secondary tricuspid regurgitation (A-STR) is a distinct phenotype of secondary tricuspid regurgitation with predominant dilation of the right atrium and normal right and left ventricular function. Atrial secondary tricuspid regurgitation occurs most commonly in elderly women with atrial fibrillation and in heart failure with preserved ejection fraction in sinus rhythm. In A-STR, the main mechanism of leaflet malcoaptation is related to the presence of a significant dilation of the tricuspid annulus secondary to right atrial enlargement. In addition, there is an insufficient adaptive growth of tricuspid valve leaflets that become unable to cover the enlarged annular area. As opposed to the ventricular phenotype, in A-STR, the tricuspid valve leaflet tethering is typically trivial. The A-STR phenotype accounts for 10%–15% of clinically relevant tricuspid regurgitation and has better outcomes compared with the more prevalent ventricular phenotype. Recent data suggest that patients with A-STR may benefit from more aggressive rhythm control and timely valve interventions. However, little is mentioned in current guidelines on how to identify, evaluate, and manage these patients due to the lack of consistent evidence and variable definitions of this entity in recent investigations. This interdisciplinary expert opinion document focusing on A-STR is intended to help physicians understand this complex and rapidly evolving topic by reviewing its distinct pathophysiology, diagnosis, and multi-modality imaging characteristics. It first defines A-STR by proposing specific quantitative criteria for defining the atrial phenotype and for discriminating it from the ventricular phenotype, in order to facilitate standardization and consistency in research.

中文翻译：

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心房继发性三尖瓣反流：病理生理学、定义、诊断和治疗

心房继发性三尖瓣反流 (A-STR) 是继发性三尖瓣反流的一种独特表型，以右心房扩张为主，左右心室功能正常。心房继发性三尖瓣反流最常见于患有房颤的老年女性和窦性心律射血分数保留的心力衰竭。在 A-STR 中，小叶接合不良的主要机制与继发于右心房扩大的三尖瓣环的显着扩张有关。此外，三尖瓣小叶适应性生长不足，无法覆盖扩大的环形区域。与心室表型相反，在 A-STR 中，三尖瓣小叶栓系通常是微不足道的。A-STR 表型占临床相关三尖瓣反流的 10%–15%，并且与更常见的心室表型相比具有更好的结果。最近的数据表明，A-STR 患者可能受益于更积极的节律控制和及时的瓣膜干预。然而，由于在最近的调查中缺乏一致的证据和对该实体的不同定义，当前指南中很少提及如何识别、评估和管理这些患者。这份专注于 A-STR 的跨学科专家意见文件旨在通过回顾其独特的病理生理学、诊断和多模态成像特征，帮助医生理解这一复杂且快速发展的主题。它首先通过提出定义心房表型并将其与心室表型区分开来的具体定量标准来定义A-STR，以促进研究的标准化和一致性。