Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

Seo, Jiwon; Kim, Dae Young; Cho, Iksung; Hong, Geu Ru; Ha, Jong Won; Shim, Chi Young

doi:10.1371/journal.pone.0235230

Cited by 34 publications

(33 citation statements)

References 25 publications

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“…Atrial fibrillation was found to represent a risk factor for CIED-associated progression of TR [ 17 , 29 ]. In our univariate regression for progression of TR, atrial fibrillation and single ventricular pacing lead was found to be significantly associated with progression of TR.…”

Section: Discussionmentioning

confidence: 99%

“…Interference of a right ventricular transtricuspid pacing lead with the tricuspid valve might contribute to or cause TR, and is reported in 7% to 45% of RV lead implantations [11]. RV leads of cardiac implantable electronic devices (CIEDs) are associated with progression of TR, which is associated with poor outcomes [12][13][14][15][16][17]. Lead-associated TR affects long-term RV function, which is linked to decreased survival [18].…”

Section: Introductionmentioning

confidence: 99%

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Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

et al. 2021

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Background Transcatheter tricuspid valve intervention became an option for pacemaker lead-associated tricuspid regurgitation. This study investigated the progression of tricuspid regurgitation (TR) in patients with or without pre-existing right ventricular dilatation (RVD) undergoing pacemaker implantation. Methods Patients were included if they had implantation of transtricuspid pacemaker lead and completed echocardiography before and after implantation. The cohort was divided in patients with and without RVD (cut-off basal RV diameter ≥ 42 mm). TR was graded in none/mild, moderate, and severe. Worsening of one grade was defined as progression. Survival analyses were plotted for 10 years. Results In total, 990 patients were analyzed (24.5% with RVD). Progression of TR occurred in 46.1% of patients with RVD and in 25.6% of patients without RVD (P < 0.001). Predictors for TR progression were RV dilatation (OR 2.04; 95% CI 1.27–3.29; P = 0.003), pre-existing TR (OR 4.30; 95% CI 2.51–7.38; P < 0.001), female sex (OR 1.68; 95% CI 1.16–2.43; P = 0.006), single RV lead (OR 1.67; 95% CI 1.09–2.56; P = 0.018), mitral regurgitation (OR 2.08; 95% CI 1.42–3.05; P < 0.001), and enlarged left atrium (OR 1.98; 95% CI 1.07–3.67; P = 0.03). Survival-predictors were pacemaker lead-associated TR (HR 1.38; 95% CI 1.04–1.84; P = 0.028), mitral regurgitation (HR 1.34; 95% CI 1.02–1.77; P = 0.034), heart failure (HR 1.75; 95% CI 1.31–2.33; P < 0.001), kidney disease (HR 1.62; 95% CI 1.25–2.11; P < 0.001), and age ≥ 80 years (HR 2.84; 95% CI 2.17–3.71; P < 0.001). Conclusions Patients with RVD receiving pacemaker suffered from increased TR progression, leading to decreased survival. Graphic abstract

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

et al. 2021

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“…The prevalence of lead-dependent tricuspid valve dysfunction is assessed in wide ranges depending on the studied population and the follow-up period after CIED implantation. According to previous studies comparing valve function before and after implantation, deterioration of tricuspid regurgitation is found in 7–45% of patients in Period 1 month to 6.5 years [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 15 ]. In the present study, the incidence of LDTVD was relatively low—4.44%, however, in the current analysis TV function before and after CIED implantation was not compared, only influence of the lead on TV at various times after implantation (average time was about 8 years) as well as possible reduction of TR and survival after lead extraction procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Previous researches were often based on small populations with a short follow-up period and sometimes did not include pre-implantation echocardiography. Currently, there have been several reports assessing the occurrence of LDTVD in a large group of patients and a longer follow-up period after CIED implantation [ 15 , 16 , 17 ]. All these studies confirm the incidence of LDTVD increasing over time and look for potential risk factors for worsening of tricuspid valve function.…”

Section: Introductionmentioning

confidence: 99%

Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis

Polewczyk

Jacheć

Nowosielecka

et al. 2021

JCM

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Background: Lead-related tricuspid valve dysfunction (LDTVD) has not been studied in a large population and its management remains controversial. Methods: An analysis of the clinical data of 2678 patients undergoing transvenous lead extraction (TLE) in years 2008–2021 was conducted, with a separate group of 119 patients with LDTVD. Potential risk factors for LDTVD, improvement in valve function, and long-term prognosis after TLE were assessed. Results: LDTVD was diagnosed in 4.44% of patients referred for lead extraction due to different reasons. The most common mechanism of LDTVD was propping upward or clamping down the leaflet by the lead (85.71%). The probability of LDTVD was higher in female sex, patients with valvular heart disease, atrial fibrillation, heart failure, large right ventricle and high pulmonary artery systolic pressure, the presence of only pacing lead, and in case of collision of the lead with tricuspid valve and adhesion of the lead to the heart structures. The prognosis of patients with LDTVD was worse, however, patients with improved valve function after TLE showed a significantly better long-term survival. Conclusions: Lead dependent tricuspid valve dysfunction is a potentially serious condition that requires thorough diagnostics and thoughtful management. The risk factors for LDTVD are primarily related to the course of the lead and its adhesion to the heart structures. Improvement of tricuspid valve function after TLE is observed in 35.29% of patients Patients with LDTVD have a worse long-term survival, but the improvement in valve function following TLE contributes to a significant reduction in mortality.

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“…As the population ages, not only is the number of patients receiving permanent PM implantation increasing, but so is the occurrence of heart failure after PM implantation. (20,21). PMIC has emerged as one of the most important complications of PM implantation, and its incidence is increasing, increasing the need to upgrade to cardiac resynchronization therapy (4).…”

Section: Usefulness Of Lv-gls In Patients Who Underwent Pm Implantationmentioning

confidence: 99%

Left Ventricular Global Longitudinal Strain Is Associated With Cardiovascular Outcomes in Patients Who Underwent Permanent Pacemaker Implantation

Kim

Lkhagvasuren

Seo

et al. 2021

Front. Cardiovasc. Med.

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Background: Patients who underwent permanent pacemaker (PM) implantation have a potential risk of left ventricular (LV) systolic dysfunction. However, assessment of LV ejection fraction (LVEF) shows a limited role in identifying subclinical LV systolic dysfunction and predicting cardiovascular (CV) outcomes.Methods: We reviewed 1,103 patients who underwent permanent PM implantation between January 2007 and December 2017. After excluding patients who did not undergo echocardiograms before or after PM implantation and those with LV ejection fraction (LVEF) <50%, significant valve dysfunction, and history of cardiac surgery before PM implantation, 300 (67 ± 13 years, 119 men) were finally analyzed. LV mechanical function was assessed with LV global longitudinal strain (LV-GLS) using 2-dimensional speckle-tracking echocardiography. CV outcomes were defined as a composite of CV death and hospitalization for heart failure.Results: At 44 ± 28 months after post-PM echocardiogram, 23 patients (7.7%) had experienced CV outcomes. Patients with CV outcomes were older and had more comorbidities and a lower baseline |LV-GLS| than those without CV outcomes. LV mechanical function worsened after PM implantation in patients with CV outcomes. The cut-off value of 11.2% in |LV-GLS| on post-PM echocardiogram had a better predictive value for CV outcomes (AUC; 0.784 vs. 0.647, p = 0.012). CV outcome in patients with |LV-GLS| <11.2% was worse than that in those with |LV-GLS| ≥ 11.2% (log-rank p < 0.001). Multivariate Cox model revealed that reduced |LV-GLS| was independently associated with CV outcomes.Conclusions: Pacing deteriorates LV mechanical function. Impaired LV-GLS is associated with poor CV outcomes in patients who underwent PM implantation.

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Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

Cited by 34 publications

References 25 publications

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Pacemaker lead-associated tricuspid regurgitation in patients with or without pre-existing right ventricular dilatation

Lead Dependent Tricuspid Valve Dysfunction-Risk Factors, Improvement after Transvenous Lead Extraction and Long-Term Prognosis

Left Ventricular Global Longitudinal Strain Is Associated With Cardiovascular Outcomes in Patients Who Underwent Permanent Pacemaker Implantation

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