Progressive tricuspid regurgitation and elevated pressure gradient after transvenous permanent pacemaker implantation

Objective To determine the prevalence of tricuspid regurgitation in patients with dual-chamber permanent pacemaker implantation. Methods This study included 153 patients undergoing permanent pacemaker implantation. All eligible candidates had baseline transthoracic echocardiography to rule out preexisting tricuspid regurgitation. Echocardiography across the tricuspid valve was repeated one month after permanent pacemaker implantation, and the frequency of significant tricuspid regurgitation was determined. The associations of potential effect modifiers (age, sex, height, body mass index categories, diabetes, and hypertension) with tricuspid regurgitation were assessed individually using simple and multivariable logistic regression models. Results After dual-chamber permanent pacemaker implantation, significant tricuspid regurgitation was present in 22 (15.8%) patients. Tricuspid regurgitation was significantly associated with body mass index >30 kg·m−2 (odds ratio = 32.84, 95% confidence interval: 1.26–853.82, p = 0.04). Conclusion Significant tricuspid regurgitation was present in substantial number of patients after dual-chamber pacemaker implantation and was independently associated with body mass index >30 kg·m−2.

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Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient after Transvenous Permanent Pacemaker Implantation

10.21203/rs.3.rs-58129/v2 ◽

2020 ◽

Author(s):

Weichieh Lee ◽

Hsiu-Yu Fang ◽

Huang-Chung Chen ◽

Yung-Lung Chen ◽

Tzu-Hsien Tsai ◽

...

Keyword(s):

Heart Failure ◽

Pressure Gradient ◽

Tricuspid Regurgitation ◽

Independent Predictor ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Dual Chamber ◽

Valvular Surgery ◽

Group 2 ◽

Group 1

Abstract Background The association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation. Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant. Results 198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG, whereas 877 patients (group 2) did not have progressive post-implant TR. Group 1 had larger change in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) was an independent predictor of progressive post-implant TR. Conclusions After a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG was an independent predictor of progressive post-implant TR.

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Genesis of tricuspid regurgitation after permanent pacemaker implantation: two-dimensional and M-mode echocardiographic study

Choonpa Igaku ◽

10.3179/jjmu.38.111 ◽

2011 ◽

Vol 38 (2) ◽

pp. 111-117

Author(s):

Sayuki KOBAYASHI ◽

Terumi HAYASHI ◽

Michiko MINAI ◽

Hiroko ZENRI ◽

Michiko ICHIHARA ◽

...

Keyword(s):

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Two Dimensional ◽

Permanent Pacemaker Implantation ◽

Echocardiographic Study

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073_16746-J4 Incidence and Predictors of Moderate to Severe Tricuspid Regurgitation After Permanent Pacemaker Implantation; Clinical Implications of Atrial Fibrillation on Its Progression

JACC: Clinical Electrophysiology ◽

10.1016/j.jacep.2017.09.079 ◽

2017 ◽

Vol 3 (10) ◽

pp. S17-S18

Author(s):

K-J. Choi

Keyword(s):

Atrial Fibrillation ◽

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Clinical Implications ◽

Severe Tricuspid Regurgitation ◽

Permanent Pacemaker Implantation

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Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient After Transvenous Permanent Pacemaker Implantation

10.21203/rs.3.rs-58129/v1 ◽

2020 ◽

Author(s):

Weichieh Lee ◽

Hsiu-Yu Fang ◽

Huang-Chung Chen ◽

Yung-Lung Chen ◽

Tzu-Hsien Tsai ◽

...

Keyword(s):

Heart Failure ◽

Pressure Gradient ◽

Tricuspid Regurgitation ◽

Left Atrial ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Dual Chamber ◽

Valvular Surgery ◽

Group 2 ◽

Group 1

Abstract BackgroundThe association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation.Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant.Results198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG. Group 1 had l larger changes in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2 without progressive post-implant TR. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) and post-implant left atrial dimension (HR: 1.076; 95% CI: 1.038-1.114; p < 0.001) were independent predictors of progressive post-implant TR. ConclusionsAfter a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG and larger post-implant LA dimension were independent predictors of progressive post-implant TR.

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Comparative early outcomes of tricuspid Valve repair versus replacement for secondary tricuspid regurgitation

Open Heart ◽

10.1136/openhrt-2018-000878 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000878 ◽

Cited By ~ 11

Author(s):

Mohamad Alkhouli ◽

Chalak Berzingi ◽

Amer Kowatli ◽

Fahad Alqahtani ◽

Vinay Badhwar

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Pacemaker Implantation ◽

Permanent Pacemaker ◽

Hospital Death ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Permanent Pacemaker Implantation

BackgroundComparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited.MethodsWe used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR.ResultsA total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, which were more common in the TVR group. Before propensity matching, in-hospital mortality was similar between patients who underwent isolated TVr and TVR (8.1% vs 10.8%, p=0.093), but the incidence of postoperative morbidities differed: TVR was associated with higher rates of permanent pacemaker implantation and blood transfusion, while TVr was associated with more acute kidney injury. After rigorous propensity score matching, TVR was associated with significantly higher rates of in-hospital death (12% vs 6.9%, p=0.009) and permanent pacemaker implantation (33.7% vs 11.2%, p<0.001). Postoperative morbidities and length of stay, however, were not different between the two groups. Nonetheless, cost of hospitalisation was 16% higher in the TVr group.ConclusionsIn patients undergoing isolated surgery for secondary TR, TVR is associated with higher in-hospital mortality and need for permanent pacemaker compared with TVr. Further studies are needed to understand the impact of the type of surgery on the short-term and long-term mortality in this complex undertreated population.

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