Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up

Höke, Ulas; Auger, Dominique; Thijssen, Joep; Wolterbeek, Ron; Velde, Enno T. van der; Holman, Eduard R.; Schalij, Martin J.; Bax, Jeroen J.; Delgado, Victoria; Marsan, Nina Ajmone

doi:10.1136/heartjnl-2013-304673

Cited by 172 publications

(111 citation statements)

References 27 publications

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“…Most of these studies have focused on change of TR following PPM implantation rather than on comparing TR in a group with and without a PPM lead. 8–11 Among the small studies with a referent group, 6,7 the prevalence of STR ranged between 25–29% in patients with a lead versus 12–13% without a lead (p < 0.05). Other investigators have not found evidence of worsening of TR with PPM implantation.…”

Section: Discussionmentioning

confidence: 99%

“…It is largely based on case reports or observational studies, often shows discordant results, 5 lacks data on outcomes, 5–9 or fails to include a control group without an implantable device. 10, 11 Similarly, some studies include patients with ICDs and/or CRT devices, 10, 11 who usually have depressed left ventricular (LV) systolic function and advanced heart failure, leading to strong confounding by indication. We sought to establish whether patients with transvenous PPM leads have an increased risk of STR and to determine all-cause mortality associated with lead-related TR in a large longitudinal single-center cohort.…”

Section: Introductionmentioning

confidence: 99%

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Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads

Delling

Hassan

Piatkowski

et al. 2016

The American Journal of Cardiology

127

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Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥ 3+) among all echocardiograms performed between 2005 and 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular (LV) systolic/diastolic function, and pulmonary artery hypertension. We screened 93592 echocardiograms (1245 with PPM) among 58556 individual patients (634 with PPM). The prevalence of STR was higher in patients following PPM placement (mean age 79 ± 3 years; 54% males) compared to patients without a PPM (adjusted odds ratio 2.32, 95% confidence interval [CI], 1.54–3.49; p<0.0001). Among patients with a PPM lead, the presence of STR was associated with increased mortality (adjusted hazard ratios [HR] 1.40, 95% CI 1.04–2.11, p=0.027 versus no STR). Compared to having neither a PPM lead nor STR, adjusted HR for death were 2.13 (95% CI, 1.93–2.34) for STR but no PPM, 1.04 (0.89–1.22) for PPM without STR, and 1.55 (1.13–2.14) for PPM with STR. In conclusion, in a sample comprising over 58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for LV systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads

Delling

Hassan

Piatkowski

et al. 2016

The American Journal of Cardiology

127

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“…In addition, 18 patients with severe renal dysfunction undergoing implantable cardioverter defibrillator (ICD) implantation, matched for age, sex, and LVEF, were selected as the control group. All devices were conventionally implanted in the pectoral region as previously described (12,13).…”

Section: Patient Populationmentioning

confidence: 99%

Cardiac Resynchronization Therapy in CKD Stage 4 Patients

Höke

Khidir

Velde

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Cardiac resynchronization therapy (CRT) is a well established heart failure treatment that has shown to improve renal function. However, landmark CRT trials excluded patients with severe renal dysfunction. Therefore, this study evaluated the effect of CRT on renal function and long-term prognosis in patients with stage 4 CKD.Design, setting, participants, & measurements This study evaluated 73 consecutive CRT patients (71610 years) with stage 4 CKD who underwent echocardiographic and renal function evaluation at baseline and 6-month follow-up between 2000 and 2012. As a control group, 18 patients with stage 4 CKD who received an implantable cardioverter defibrillator (ICD) were selected. CRT recipients with $15% reduction in left ventricular end-systolic volume at 6-month follow-up were classified as CRT responders. During long-term follow-up (median, 33 months), appropriate defibrillator therapy, heart failure hospitalizations, and all-cause mortality (combined end point) were recorded.Results At 6-month follow-up, a significant reduction in left ventricular end-systolic volume was observed in CRT patients compared with patients with ICD (from 159678 to 145678 ml in CRT patients and from 126654 to 119649 ml in ICD patients; P=0.05), and CRT response was observed in 22 patients (30%). Compared with ICD patients, eGFR improved among CRT patients (from 2564 to 3069 ml/min per 1.73 m 2 ; interaction time and group, P=0.04) and was more pronounced among CRT responders (2563 to 3469 ml/min per 1.73 m 2 ; P,0.001). The combined end point was observed in 17 ICD and 62 CRT patients. CRT patients showed superior survival compared with ICD patients (log-rank P=0.03). More importantly, CRT response was independently associated with improved survival free from the combined end point (hazard ratio, 0.51; 95% confidence interval, 0.27 to 0.98; P=0.04) after adjustment for clinical and echocardiographic parameters.Conclusions Response to CRT occurs in approximately 30% of patients with stage 4 CKD, which is less than in the average CRT population. CRT was associated with better clinical outcome, and particularly, CRT response was associated with improvement in eGFR and better long-term prognosis.

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“…Hoke et al provide us with more data, obtained retrospectively, on RV lead-associated tricuspid regurgitation from 239 patients who underwent de novo device implantation (191 implantable cardioverter-defibrillators and 28 pacemakers) between January 2002 and January 2009 at a single centre 10. In their study, grade 1 or 2 tricuspid regurgitation was present in 64% (153 patients), grade 3 tricuspid regurgitation in 2% (5 patients) prior to device implantation; 34% (91 patients) had no evidence of tricuspid regurgitation.…”

mentioning

confidence: 99%

“…However, even in the absence of leaflet perforation, damage to the valve leaflets or annular dilatation and right-sided chamber enlargement can occur as early as 1–1.5 years after device implantation 7 10. In this setting, extraction of the RV lead is unlikely to improve the degree of tricuspid regurgitation or outcome 17…”

mentioning

confidence: 99%