Abstract 12543: Tricuspid Regurgitation Predicts Mortality after Cardiac Resynchronization Therapy (CRT)
Introduction: Although tricuspid regurgitation (TR) is common among heart failure (HF) patients, its impact on outcome in CRT patients remains poorly understood.
Methods: 336 patients undergoing CRT with echocardiographic imaging data at baseline and follow-up were prospectively studied. A primary composite endpoint of all-cause death or time to first HF hospitalization was assessed at 3 years. TR was classified into 4 grades per the ASE guidelines. TR response was defined as reduction of ≥1 grade in a patient with at least mild TR at baseline.
Results: Baseline TR severity was significantly associated with an increased risk of the primary endpoint at 3 years (Figure, Panel A). In particular, all-cause mortality worsened with degree of TR and persisted even after adjustment for change in LVEF and LV dimension (HR 1.55 95% CI 1.29 to 1.85, p<0.0001). Improvement in TR after CRT was associated with a reduced risk of the primary endpoint (Figure, Panel B) (HR 0.55 95% CI 0.37 to 0.83, p=0.004), including a significant reduction in mortality (HR 0.53 95% CI 0.30 to 0.94, p=0.029) and significantly greater improvement in LVEF (+11.0 ± 13.0% in TR responders vs. 5.6 ± 11.4% in nonresponders, p=0.005). Multivariate predictors of TR response included higher baseline TR grade (p<0.0001), absence of chronic diuretic therapy at baseline (p=0.048), improvement in LVEF (p=0.003), and mean pulmonary artery pressure (PA) reduction after CRT (p=0.054). Baseline PA pressure was not predictive (p=0.762) of TR response.
Conclusion: Increased TR severity at baseline is associated with increased all-cause mortality in CRT patients, independent of LV remodeling. Patients with TR improvement after CRT demonstrate improved echocardiographic and clinical outcomes, including reduced mortality.
- © 2012 by American Heart Association, Inc.