Abstract 16769: Prevalence of Tricuspid Regurgitation Increases after Cardiac Device Implantation
Background: There is limited and conflicting data regarding the prevalence of tricuspid regurgitation (TR) due to implantable cardiac devices (implantable cardiac defibrillator, ICD; permanent pacemaker, PPM).
Methods: We analyzed 2,746 patients who had cardiac devices implanted between 2005 and 2011 at Cleveland Clinic and had at least one pre-implantation TR measurement. A total of 3,566 post-operative echocardiograms were available for 1,596 patients (median follow-up 10 months). Data were analyzed using a cumulative logistic mixed-effects model to assess the temporal trend of TR prevalence.
Results: Of the entire group, 1,620 (59%) had an ICD and, 1,126 (41%) had a PPM. The mean age was 65 years and 62% of them were men. One-year and five-year survival was 90% and 70%, respectively. The percentage of patients with grade 0/1+ TR decreased from 44% pre-implantation to 32% at 4 years. Conversely, the percentage of patients with grade 3+ TR increased from 18% to 23% at 4 years, and the percentage with grade 4+ TR increased from 7% to 11% by 4 years. Analysis of these changes overtime revealed an acute increase (within 1 month) in those patients with TR 3+ (18% to 21%) or 4+ (7% to 10%), followed by a gradual further increase out to 4 years (21% to 23% and 10% to 11%, respectively) (Figure). Neither device type (ICD vs. PPM) (p > 0.8) nor the number of leads placed (p > 0.2) was associated with a higher grade of post-implantation TR.
Conclusion: Cardiac device implantation is associated with a significant increase in the prevalence of moderate and severe TR, and this occurs both acutely and in the chronic period after implantation. The increase in TR is similar with both ICD and PPM, and is not related to the number of leads implanted.
- © 2012 by American Heart Association, Inc.