Abstract 18876: Increased Tricuspid Regurgitation after Cardiac Resynchronization Therapy Device Implantation is Associated with Reduced Likelihood of Left Ventricular Reverse Remodeling
Background: Increased tricuspid regurgitation (TR) is a potential consequence of pacemaker and defibrillator lead insertion. We examined the association between increased TR following cardiac resynchronization therapy (CRT) device implantation and left ventricular (LV) reverse remodeling.
Methods: Patients who underwent de-novo CRT-D device implantation at our institution from 2003 to 2011 with available baseline and follow-up echocardiograms were included in this retrospective analysis. Pre- and post-operative echocardiograms were evaluated for change in degree of TR and evidence of LV reverse remodeling. TR was graded as absent (0), minimal (0.5), mild (1), mild-moderate (1.5), moderate (2), moderate-severe (2.5), or severe (3), and the numeric change in TR grade pre- and post-CRT implantation was determined. LV reverse remodeling was defined as an absolute improvement in LV ejection fraction (EF) ≥5%, a relative reduction in LV end diastolic dimension ≥10%, or improvement in mitral regurgitation ≥1 full grade.
Results: A total of 101 patients were included. Median time to post-operative echocardiogram was 8.5 months, with an interquartile range of 4.7-15.1 months. Seventeen patients (17%) developed ≥1 full grade increase in TR post CRT-D. Only four of the 17 (24%) with ≥1 full grade increase in TR had evidence of LV reverse remodeling, compared with 46 of 84 (55%) with <1 full grade increase (p = 0.031). In multivariate analysis, increase in TR post-device implant by ≥ 1 grade, baseline EF ≥ 35%, absence of baseline left bundle branch block, and male gender were independently associated with reduced likelihood of LV reverse remodeling.
Conclusions: In patients undergoing de-novo CRT-D implantation for standard indications, increased TR of ≥ 1 full grade after device implantation is independently associated with a reduced likelihood of LV reverse remodeling. Prospective studies are needed to determine if lead-related TR adversely impacts response to CRT.
- © 2012 by American Heart Association, Inc.