Incidence and Prognostic Implications of Cardiac Implantable Device-Associated Tricuspid Regurgitation: A Meta-analysis and Meta-regression Analysis

• Published in: The American journal of cardiology Vol. 209; pp. 203 - 211
• Main Authors: Safiriyu, Israel, Mehta, Adhya, Mayowa, Adefuye, Nagraj, Sanjana, Kharawala, Amrin, Adrija, Hajra, Kokkinidis, Damianos G., Shamaki, Garba Rimamskep, Bob-Manuel, Tamunoinemi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.12.2023; Elsevier Limited
• Subjects: Aged; Bias; Cardiac arrhythmia; Cardiac Implantable Devices; Confidence intervals; Congestive heart failure; Defibrillators, Implantable - adverse effects; Ejection fraction; Electronic equipment; Female; Heart Failure - complications; Heart Failure Hospitalization; Heterogeneity; Humans; Implantable Cardioverter Defibrillator; Incidence; Meta-analysis; Morbidity; Mortality; Pacemaker; Population; Population studies; Prognosis; Regression Analysis; Regression models; Regurgitation; Retrospective Studies; Statistical analysis; Stroke Volume; Systematic review; Transplants & implants; Tricuspid Valve Insufficiency - complications; Ventricle; Ventricular Function, Left; Heart Failure Hospitalization; Implantable Cardioverter Defibrillator; Pacemaker; Mortality; Cardiac Implantable Devices
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.09.064

New-onset or worsening tricuspid regurgitation (TR) is a well-established complication encountered after cardiac implantable electronic devices (CIEDs). However, there are limited and conflicting data on the true incidence and prognostic implications of this complication. This study aimed to bridge this current gap in the literature. Electronic databases MEDLINE, Embase, and Web of Science were systematically searched from inception to March 2023, for studies reporting the incidence and/or prognosis of CIED-associated new or worsening TR. Potentially eligible studies were screened and selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effect model meta-analysis and meta-regression analysis were performed, and I-squared statistic was used to assess heterogeneity. A total of 52 eligible studies, with 130,759 patients were included in the final quantitative analysis with a mean follow-up period of 25.5 months. The mean age across included studies was 69.35 years, and females constituted 46.6% of the study population. The mean left ventricular ejection fraction was 50.15%. The incidence of CIED-associated TR was 24% (95%CI: 20-28%; p< 0.001) with an odds ratio (OR) of 2.44 (95%CI:1.58–3.77;p<0.001). CIED-associated TR was independently associated with an increased risk of all-cause mortality (adjusted Hazard ratio [aHR]:1.52; 95%CI:1.361.69; p<0.001), heart failure hospitalizations (aHR:1.82; 95%CI: 1.19-2.78; p=0.006), and the composite of mortality and heart failure hospitalizations (aHR:1.96; 95%CI: 1.33-2.87; p=0.001) in the follow up period. In conclusion, CIED-associated TR occurred in nearly one-fourth of patients after device implantation and was associated with an increased risk of all-cause mortality and heart failure hospitalizations.