Key result
In patients receiving a cardiac implantable electronic device, tricuspid regurgitation progression by one grade occurred more frequently in those with preserved or mildly reduced LVEF compared to those with severely reduced LVEF (43.3% vs 21.9%, p=0.033).
Why the study?
TR progression rates after CIED implantation vary widely and TR is linked to mortality and HF hospitalizations, prompting an evaluation of early TR progression and clinical outcomes.
Does baseline LVEF < 40% affect the rate of tricuspid regurgitation progression and heart failure decompensation in patients receiving a cardiac implantable electronic device?
Cohort (n=101)
No
Does baseline LVEF < 40% affect the rate of tricuspid regurgitation progression and heart failure decompensation in patients receiving a cardiac implantable electronic device?
Answers are grounded in this paper and cite their sources.
CIED implantation is associated with early progression of tricuspid regurgitation in roughly a third of patients, with the emergence of severe or massive regurgitation primarily restricted to those with baseline LVEF < 40%.
The frequency of tricuspid regurgitation (TR) progression after cardiac implantable electronic devices (CIEDs) implantation varies from 7.2% to 44.7%. TR is associated with increased mortality and hospitalizations due to heart failure (HF) decompensation. The aim of this study was to assess the rate of early TR progression after CIED implantation and the frequency of HF decompensation and mortality. The 101 patients, who received a CIED between March 2020 and October 2021, before the procedure were divided into two groups–one with left ventricle ejection fraction (LVEF) ≥ 40% (n = 60) and one with LVEF < 40% (n = 41). Lead-related tricuspid regurgitation (LRTR) was defined as an increase of TR by at least one grade. The follow-up period was similar between both groups and was on average 13 (12–16) months. In the whole study group, TR progression by one grade was 34.6% and by two or more grades 15.8%. The significant changes in the dynamic of TR degree were as follows before and after implantation: none/trivial TR in group 1 (61.7% vs. 28.3%, p = 0.01) and severe/massive TR in group 2 (0.0% vs. 14.6%, p = 0.03). The groups did not differ from each other in terms of survival from decompensation of HF (18.3% vs. 36.6%, p = 0.70) and survival from death (1.7% vs. 4.9%, p = 0.16). At the one-year follow-up, the baseline LVEF did not affect the survival rate from death or HF decompensation among patients with a progression of TR after CIED implantation. In this study, a progression by one grade was more common in group 1, but the occurrence of severe/massive TR after implantation was more specific for group 2.
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Chodór-Rozwadowska et al. (2023) conducted a cohort in Patients requiring a cardiac implantable electronic device (CIED) (n=101). Severely reduced ejection fraction (LVEF < 40%) vs. Preserved and mildly reduced ejection fraction (LVEF ≥ 40%) was evaluated on Tricuspid regurgitation (TR) progression by one grade (p=0.033). In patients receiving a cardiac implantable electronic device, tricuspid regurgitation progression by one grade occurred more frequently in those with preserved or mildly reduced LVEF compared to those with severely reduced LVEF (43.3% vs 21.9%, p=0.033).
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