Advertisement

Effects of Tricuspid Valve Regurgitation on Outcome in Patients With Cardiac Resynchronization Therapy

Published:January 05, 2015DOI:https://doi.org/10.1016/j.amjcard.2014.12.046
      Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT. The patients were divided into groups according to baseline TR grade and according to worsening TR within 15 months after device implantation. Outcome was assessed by clinical and echocardiographic response within 15 months and by estimated survival for a median interquartile range follow-up time of 3.3 years (1.6, 4.6). TR worsening after CRT implantation was documented in 104 patients (15%). These patients had worse clinical and echocardiographic response to CRT, but worsening of TR was not a significant predictor of mortality (p = 0.17). According to baseline echocardiogram, 620 patients (90%) had some degree of TR before CRT implant. Baseline TR was an independent predictor of worse survival (p <0.001), although these patients had significantly better clinical and echocardiographic response compared with patients without TR. In conclusion, worsening of TR after CRT implantation is a predictor of worse clinical and echocardiographic response but was not significantly associated with increased mortality. Baseline TR is associated with reduced survival despite better clinical and echocardiographic response after CRT implantation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Abraham W.T.
        • Fisher W.G.
        • Smith A.L.
        • Delurgio D.B.
        • Leon A.R.
        • Loh E.
        • Kocovic D.Z.
        • Packer M.
        • Clavell A.L.
        • Hayes D.L.
        • Ellestad M.
        • Trupp R.J.
        • Underwood J.
        • Pickering F.
        • Truex C.
        • McAtee P.
        • Messenger J.
        • MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation
        Cardiac resynchronization in chronic heart failure.
        N Engl J Med. 2002; 346: 1845-1853
        • Cazeau S.
        • Leclercq C.
        • Lavergne T.
        • Walker S.
        • Varma C.
        • Linde C.
        • Garrigue S.
        • Kappenberger L.
        • Haywood G.A.
        • Santini M.
        • Bailleul C.
        • Daubert J.C.
        • Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators
        Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay.
        N Engl J Med. 2001; 344: 873-880
        • Stellbrink C.
        • Breithardt O.A.
        • Franke A.
        • Sack S.
        • Bakker P.
        • Auricchio A.
        • Pochet T.
        • Salo R.
        • Kramer A.
        • Spinelli J.
        • PATH-CHF (PAcing THerapies in Congestive Heart Failure) Investigators; CPI Guidant Congestive Heart Failure Research Group
        Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances.
        J Am Coll Cardiol. 2001; 38: 1957-1965
        • Young J.B.
        • Abraham W.T.
        • Smith A.L.
        • Leon A.R.
        • Lieberman R.
        • Wilkoff B.
        • Canby R.C.
        • Schroeder J.S.
        • Liem L.B.
        • Hall S.
        • Wheelan K.
        • Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE ICD) Trial Investigators
        Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD trial.
        JAMA. 2003; 289: 2685-2694
        • Padeletti L.
        • Paoletti Perini A.
        • Gronda E.
        Cardiac resynchronization therapy: the issue of non-response.
        Heart Fail Rev. 2012; 17: 97-105
        • Abu Sham'a R.
        • Buber J.
        • Grupper A.
        • Nof E.
        • Kuperstein R.
        • Luria D.
        • Feinberg M.S.
        • Eldar M.
        • Glikson M.
        Effects of tricuspid valve regurgitation on clinical and echocardiographic outcome in patients with cardiac resynchronization therapy.
        Europace. 2013; 15: 266-272
        • Epstein A.E.
        • Dimarco J.P.
        • Ellenbogen K.A.
        • Estes N.A.
        • Freedman R.A.
        • Gettes L.S.
        • Gillinov A.M.
        • Gregoratos G.
        • Hammill S.C.
        • Hayes D.L.
        • Hlatky M.A.
        • Newby L.K.
        • Page R.L.
        • Schoenfeld M.H.
        • Silka M.J.
        • Stevenson L.W.
        • Sweeney M.O.
        • American College of Cardiology/American Heart Association Task Force on Practice
        • American Association for Thoracic Surgery
        • Society of Thoracic Surgeons
        ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary.
        Heart Rhythm. 2008; 5: 934-955
        • Lin G.
        • Nishimura R.A.
        • Connolly H.M.
        • Dearani J.A.
        • Sundt III, T.M.
        • Hayes D.L.
        Severe symptomatic tricuspid valve regurgitation due to permanent pacemaker or implantable cardioverter-defibrillator leads.
        J Am Coll Cardiol. 2005; 45: 1672-1675
        • Kim J.B.
        • Spevack D.M.
        • Tunick P.A.
        • Bullinga J.R.
        • Kronzon I.
        • Chinitz L.A.
        • Reynolds H.R.
        The effect of transvenous pacemaker and implantable cardioverter defibrillator lead placement on tricuspid valve function: an observational study.
        J Am Soc Echocardiogr. 2008; 21: 284-287
        • Klutstein M.
        • Balkin J.
        • Butnaru A.
        • Ilan M.
        • Lahad A.
        • Rosenmann D.
        Tricuspid incompetence following permanent pacemaker implantation.
        Pacing Clin Electrophysiol. 2009; 32: S135-137
        • Al-Mohaissen M.A.
        • Chan K.L.
        Prevalence and mechanism of tricuspid regurgitation following implantation of endocardial leads for pacemaker or cardioverter-defibrillator.
        J Am Soc Echocardiogr. 2012; 25: 245-252
        • Ghio S.
        • Gavazzi A.
        • Campana C.
        • Inserra C.
        • Klersy C.
        • Sebastiani R.
        • Arbustini E.
        • Recusani F.
        • Tavazzi L.
        Independent and additive prognostic value of right ventricular systolic function and pulmonary pressure in patients with chronic heart failure.
        J Am Coll Cardiol. 2001; 37: 183-188
        • Gavazzi A.
        • Berzuini C.
        • Campana C.
        • Inserra C.
        • Ponzetta M.
        • Sebastiani R.
        • Ghio S.
        • Recusani F.
        Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure.
        J Heart Lung Transplant. 1997; 16: 774-785
        • Chung E.S.
        • Leon A.R.
        • Tavazzi L.
        • Sun J.P.
        • Nihoyannopoulos P.
        • Merlino J.
        • Abraham W.T.
        • Ghio S.
        • Leclercq C.
        • Bax J.J.
        • Yu C.M.
        • Gorcsan III, J.
        • St John Sutton M.
        • De Sutter J.
        • Murillo J.
        Results of the Predictors of Response to CRT (PROSPECT) trial.
        Circulation. 2008; 117: 2608-2616
        • Stern J.
        • Heist E.K.
        • Murray L.
        • Alabiad C.
        • Chung J.
        • Picard M.H.
        • Semigran M.J.
        • Ruskin J.N.
        • Singh J.P.
        Elevated estimated pulmonary artery systolic pressure is associated with an adverse clinical outcome in patients receiving cardiac resynchronization therapy.
        Pacing Clin Electrophysiol. 2007; 30: 603-607
        • Alpendurada F.
        • Guha K.
        • Sharma R.
        • Ismail T.F.
        • Clifford A.
        • Banya W.
        • Mohiaddin R.H.
        • Pennell D.J.
        • Cowie M.R.
        • McDonagh T.
        • Prasad S.K.
        Right ventricular dysfunction is a predictor of non-response and clinical outcome following cardiac resynchronization therapy.
        J Cardiovasc Magn Reson. 2011; 31: 13-68
        • Asirvatham S.J.
        • Bruce C.J.
        • Danielsen A.
        • Johnson S.B.
        • Okumura Y.
        • Kathmann E.
        • Packer D.L.
        • Friedman P.A.
        Intramyocardial pacing and sensing for the enhancement of cardiac stimulation and sensing specificity.
        PACE. 2007; 30: 748-754
        • Henz B.D.
        • Friedman P.A.
        • Bruce C.J.
        • Okumura Y.
        • Johnson S.B.
        • Danielsen A.
        • Packer D.L.
        • Asirvatham S.J.
        Synchronous ventricular pacing without crossing the tricuspid valve or entering the coronary sinus—preliminary results.
        J Cardiovasc Electrophysiol. 2009; 20: 1391-1397
        • Cooper J.A.
        • Latacha M.P.
        • Soto G.E.
        • Garmany R.G.
        • Gleva M.J.
        • Chen J.
        • Faddis M.N.
        • Smith T.W.
        The azygos defibrillator lead for elevated defibrillation thresholds: implant technique, lead stability, and patient series.
        Pacing Clin Electrophysiol. 2008; 31: 1405-1410
        • Grimard C.
        • May M.A.
        • Mabo P.
        • Babuty D.
        An original defibrillation lead implantation to avoid tricuspid prosthesis damage.
        Europace. 2010; 12: 589-590
        • Bhakta M.
        • Obioha C.C.
        • Sorajja D.
        • Srivathsan K.
        • Arabia F.A.
        • Devaleria P.A.
        • Jaroszewski D.E.
        • Scott L.R.
        • Altemose G.T.
        Nontraditional implantable cardioverter defibrillator placement in adult patients with limited venous access: a case series.
        Pacing Clin Electrophysiol. 2010; 33: 217-225
        • Hsia T.Y.
        • Bradley S.M.
        • LaPage M.J.
        • Whelan S.
        • Saul J.P.
        • Ringewald J.M.
        • Reed J.H.
        Novel minimally invasive, intrapericardial implantable cardioverter defibrillator coil system: a useful approach to arrhythmia therapy in children.
        Ann Thorac Surg. 2009; 87: 1234-1238
        • Gupta N.
        • Moore J.P.
        • Shannon K.
        A novel approach to eliminate intraventricular lead placement in patients with congenital heart disease.
        J Interv Card Electrophysiol. 2012; 35: 115-118
        • Kanzaki H.
        • Bazaz R.
        • Schwartzman D.
        • Dohi K.
        • Sade L.E.
        • Gorcsan III, J.
        A mechanism for immediate reduction in mitral regurgitation after cardiac resynchronization therapy: insights from mechanical activation strain mapping.
        J Am Coll Cardiol. 2004; 44: 1619-1625
        • Ypenburg C.
        • Lancellotti P.
        • Tops L.F.
        • Bleeker G.B.
        • Holman E.R.
        • Pierard L.A.
        • Schalij M.J.
        • Bax J.J.
        Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation.
        J Am Coll Cardiol. 2007; 50: 2071-2077
        • Agricola E.
        • Oppizzi M.
        • Galderisi M.
        • Pisani M.
        • Meris A.
        • Pappone C.
        • Margonato A.
        Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction.
        Heart. 2006; 92: 1390-1395
        • Inage T.
        • Yoshida T.
        • Hiraki T.
        • Ohe M.
        • Takeuchi T.
        • Nagamoto Y.
        • Fukuda Y.
        • Gondo T.
        • Imaizumi T.
        Chronic cardiac resynchronization therapy reverses cardiac remodelling and improves invasive haemodynamics of patients with severe heart failure on optimal medical treatment.
        Europace. 2008; 10: 379-383
        • Bleeker G.B.
        • Schalij M.J.
        • Nihoyannopoulos P.
        • Steendijk P.
        • Molhoek S.G.
        • van Erven L.
        • Bootsma M.
        • Holman E.R.
        • van der Wall E.E.
        • Bax J.J.
        Left ventricular dyssynchrony predicts right ventricular remodeling after cardiac resynchronization therapy.
        J Am Coll Cardiol. 2005; 46: 2264-2269
        • Nath J.
        • Foster E.
        • Heidenreich P.A.
        Impact of tricuspid regurgitation on long-term survival.
        J Am Coll Cardiol. 2004; 43: 405-409