Key result
Baseline moderate-to-severe TR is linked to a ~29% lower clinical response to CRT.
Why the study?
The clinical importance of tricuspid regurgitation aggravation following cardiac device implantation and its effect on CRT response is debated.
Does baseline tricuspid regurgitation severity or its exacerbation affect the clinical and echocardiographic response to cardiac resynchronization therapy in patients with congestive heart failure?
Cohort (n=70)
Yes
Does baseline tricuspid regurgitation severity or its exacerbation affect the clinical and echocardiographic response to cardiac resynchronization therapy in patients with congestive heart failure?
While cardiac resynchronization therapy may exacerbate tricuspid regurgitation, this exacerbation does not significantly impact the clinical or echocardiographic response to the therapy.
Baseline moderate-severe TR was associated with reduced CRT response; hypothesis-generating for TR as a selection modifier pending randomized trials.
Background: Aggravation of tricuspid regurgitation (TR) is a predictable issue following cardiac device implantation, while its clinical importance is subject to debate. Objectives: We aimed to recognize the alteration of TR following cardiac resynchronization therapy (CRT) and its effect on the response to CRT. Methods: In this prospective study, 70 candidates were recruited for CRT from those who visited two university hospitals in Tehran and Ahvaz (Iran) from January 2012 to March 2013. Baseline specifications were recorded for all the participants. All the patients underwent echocardiography before and 6 months after CRT administration. They were then divided into two categories for further comparison: (1) Patients with no or mild TR and (2) patients with moderate-to-severe TR. The echocardiographic response to CRT was defined as a left ventricular end-systolic volume (LVESV) decrease of >15% or left ventricular ejection fraction (LVEF) advancement of >5%. The clinical response to CRT was one class improvement based on the New York Heart Association (NYHA) class. Results: Of the patients, 24 had moderate-to-severe TR. Although the increase in cases with moderate-to-severe TR after CRT was not significant, the aggravation of TR degree after the procedure was significant (P = 0.002). Moreover, the NYHA class significantly improved after the CRT (P = 0.02). The number of cases with a clinical response to CRT based on improvement of the NYHA class was significantly greater in patients with no TR or mild TR at baseline (P = 0.003). There was no significant variation in response to CRT among patients who experienced TR exacerbation after CRT compared with those who had no change or a reduction in TR. Conclusions: This study demonstrated that TR severity was exacerbated following CRT, but this alternation in TR severity had no significant effect on the response to CRT. Therefore, the presence and development of TR before and after CRT must not affect the criteria for choosing cardiac resynchronization therapy for appropriate patients.
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Payami et al. (2023) conducted a cohort in Congestive Heart Failure (n=70). Moderate-to-severe tricuspid regurgitation vs. No or mild tricuspid regurgitation was evaluated on Clinical response to CRT (≥1 NYHA class improvement) (p=0.003). Baseline moderate-to-severe tricuspid regurgitation was associated with a lower clinical response to cardiac resynchronization therapy compared to no or mild regurgitation (66.7% vs 93.5%, p=0.003).
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