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