Nikolaos Papageorgiou1, Debbie Falconer2, Nikolas Wyeth2, Guy Lloyd3, Denis Pellerin4, Elsya Speechly-Dick5, Oliver R Segal6, Martin Lowe6, Edward Rowland6, Pier D Lambiase7, Anthony W Chow6, Sanjeev Bhattacharyya8. 1. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, UCL, London, UK. 2. University College London Hospitals NHS Trust, London, UK. 3. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; University College London Hospitals NHS Trust, London, UK; Institute of Cardiovascular Science, UCL, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK. 4. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK. 5. University College London Hospitals NHS Trust, London, UK; Institute of Cardiovascular Science, UCL, London, UK. 6. Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, UK. 7. Electrophysiology Department, Barts Heart Centre, St. Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, UCL, London, UK. 8. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; University College London Hospitals NHS Trust, London, UK; Institute of Cardiovascular Science, UCL, London, UK; William Harvey Research Institute, Queen Mary University of London, London, UK. Electronic address: Sanjeev.Bhattacharyya@bartshealth.nhs.uk.
Abstract
BACKGROUND: The long-term effect of tricuspid regurgitation (TR) after device implantation on long-term mortality remains unknown. In the present study, we sought to examine whether patients undergoing an implantable cardiac device procedure (pacemaker, cardiac defibrillator or cardiac resynchronisation therapy) have an increased risk of TR and to determine the effect of this on long-term survival. METHODS: A total of 304 patients who underwent device implant and had pre- and post-implant transthoracic echocardiogram were included in the analysis. All-cause mortality was the study endpoint over a follow-up period of median 11.6 years. RESULTS: New ≥ moderate tricuspid regurgitation post-device implantation developed in 66/304 (21.7%) patients. New right ventricular dysfunction post-device implantation occurred in 59/304 (19.4%) patients. Independent predictors of new RV dysfunction were ischaemic heart disease (OR 4.23, 95% CI 1.58 - 11.33, p = 0.004), left ventricular impairment (OR 2.74, 95% CI 5.41 - 30.00, p < 0.0001) and new ≥ moderate TR (OR 7.72, 95% CI 3.27 - 18.23, p < 0.001). Independent predictors of mortality were new ≥ moderate TR [HR: 3.14 (95% CI 1.29 - 7.63) p = 0.01] and new RV impairment [HR: 2.82 (95% CI 1.33 - 5.98) p = 0.01. CONCLUSIONS: Worsening TR and RV dysfunction post-device implantation is common. New post-implant ≥ moderate TR is associated with increased risk of new RV impairment and poor long term (>10 years) survival.
BACKGROUND: The long-term effect of tricuspid regurgitation (TR) after device implantation on long-term mortality remains unknown. In the present study, we sought to examine whether patients undergoing an implantable cardiac device procedure (pacemaker, cardiac defibrillator or cardiac resynchronisation therapy) have an increased risk of TR and to determine the effect of this on long-term survival. METHODS: A total of 304 patients who underwent device implant and had pre- and post-implant transthoracic echocardiogram were included in the analysis. All-cause mortality was the study endpoint over a follow-up period of median 11.6 years. RESULTS: New ≥ moderate tricuspid regurgitation post-device implantation developed in 66/304 (21.7%) patients. New right ventricular dysfunction post-device implantation occurred in 59/304 (19.4%) patients. Independent predictors of new RV dysfunction were ischaemic heart disease (OR 4.23, 95% CI 1.58 - 11.33, p = 0.004), left ventricular impairment (OR 2.74, 95% CI 5.41 - 30.00, p < 0.0001) and new ≥ moderate TR (OR 7.72, 95% CI 3.27 - 18.23, p < 0.001). Independent predictors of mortality were new ≥ moderate TR [HR: 3.14 (95% CI 1.29 - 7.63) p = 0.01] and new RV impairment [HR: 2.82 (95% CI 1.33 - 5.98) p = 0.01. CONCLUSIONS: Worsening TR and RV dysfunction post-device implantation is common. New post-implant ≥ moderate TR is associated with increased risk of new RV impairment and poor long term (>10 years) survival.
Authors: Dorota Nowosielecka; Wojciech Jacheć; Anna Polewczyk; Andrzej Kleinrok; Łukasz Tułecki; Andrzej Kutarski Journal: Cardiovasc Diagn Ther Date: 2021-04
Authors: Martin Riesenhuber; Andreas Spannbauer; Marianne Gwechenberger; Thomas Pezawas; Christoph Schukro; Günter Stix; Matthias Schneider; Georg Goliasch; Anahit Anvari; Thomas Wrba; Cesar Khazen; Martin Andreas; Günther Laufer; Christian Hengstenberg; Mariann Gyongyosi Journal: Clin Res Cardiol Date: 2021-02-10 Impact factor: 5.460