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

• Published in: Heart (British Cardiac Society) Vol. 100; no. 12; pp. 960 - 968
• Main Authors: Höke, Ulas, Auger, Dominique, Thijssen, Joep, Wolterbeek, Ron, van der Velde, Enno T, Holman, Eduard R, Schalij, Martin J, Bax, Jeroen J, Delgado, Victoria, Marsan, Nina Ajmone
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.06.2014
• Subjects: Age Factors; Aged; Cardiology; Chi-Square Distribution; Defibrillators, Implantable - adverse effects; Female; Heart attacks; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Hospitals, University; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mortality; Multivariate Analysis; Pacemaker, Artificial - adverse effects; Prognosis; Proportional Hazards Models; Prosthesis Design; Retrospective Studies; Risk Factors; Stroke Volume; Tertiary Care Centers; Time Factors; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - etiology; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - physiopathology; Velocity; Ventricular Function, Left; HEART FAILURE; QUALITY OF CARE AND OUTCOMES
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2013-304673

Background Although the presence of an RV lead is a potential cause of tricuspid regurgitation (TR), the clinical impact of significant lead-induced TR is unknown. Objective To evaluate the effect of significant lead-induced TR on cardiac performance and long-term outcome after cardioverter-defibrillator (ICD) or pacemaker implantation. Methods A retrospective cohort of 239 ICD (n=191) or pacemaker (n=48) recipients (age 60±14 years, 77% male) from a tertiary care university hospital, with an echocardiographic evaluation before and within 1–1.5 years after device implantation were included. Significant lead-induced TR was defined as TR worsening, reaching a grade ≥2 at follow-up echocardiography. During long-term follow-up (median 58, IQR 35–76 months), all-cause mortality and heart failure related events were recorded. Results Before device implantation, most patients had TR grade 1 or 2 (64.0%) or no TR (33.9%), but after lead placement, significant TR was seen in 91 patients (38%). Changes in cardiac volumes and function at follow-up were similar between patients with and without significant lead-induced TR, except for larger RV diastolic area (17±6mm2 vs 16±5mm2, p=0.009), larger right atrial diameter (39±10 mm vs 36±8 mm, p<0.001) and higher pulmonary arterial pressures (41±15 mm Hg vs 33±10 mm Hg, p<0.001) in patients with significant lead-induced TR. Patients with significant lead-induced TR had worse long-term survival (HR=1.687, p=0.040) and/or more heart failure related events (HR=1.641, p=0.019). At multivariate analysis, significant lead-induced TR was independently associated with all-cause mortality (HR=1.749, p=0.047) together with age, LVEF and percentage RV pacing. Conclusions Significant lead-induced TR is associated with poor long-term prognosis.