Abstract 15063: Association of Global Longitudinal Strain With Outcomes in Patients Who Develop Significant Tricuspid Regurgitation After Pacemaker/Defibrillator Implantation
Background: Development of significant tricuspid regurgitation (TR) following pacemaker/internal defibrillator (PPM/ICD) implantation, due to leaflet perforation or lack of coaptation, is occasionally observed. Global longitudinal strain (GLS) on echocardiography is a sensitive marker of regional myocardial mechanics. In a group of patients who developed significant TR, following PPM/ICD implantation, we sought to assess whether left (LV) & right ventricular (RV) GLS is independently associated with mortality.
Methods: We studied 237 consecutive patients (age 64±13 years, 70% men) with < 2+ TR at baseline, who developed ≥3+ TR within 2 years of PPM/ICD implantation. Standard echo parameters (including average RV and LV GLS, measured offline using Velocity Vector Imaging, Siemens, PA) were recorded at baseline & within 6-24 months of PPM/ICD. Society of thoracic surgeons score (STS) was calculated as a surrogate of long-term risk. Mortality was recorded.
Results: Mean baseline STS score, LV ejection fraction (LVEF), RV systolic pressure (RVSP), LV-GLS & RV-GLS were 11±11%, 27±12%, 36±10 mm Hg, -9.9±3% & -15.5±5%. 24% had 1, 43% had 2 and 33% had 3-chamber PPM/ICD. 54 % had ischemic cardiomyopathy. Mean follow-up RVSP, LV and RV-GLS (at 2 years after PPM/ICD implantation) were 36±10 mm Hg, -9.3±4% & -11.4±4%. At 6±3 years of follow-up, 3% underwent tricuspid repair/replacement, while 5% had heart transplantation and 64% died. Results of multivariate Cox Proportional Hazard analysis for long-term mortality are shown in Figure A. Survival curves separated on basis of baseline RV-GLS better or worse than median (-16%) are shown in Figure B.
Conclusion: High-risk patients who develop ≥3+ TR following PPM/ICD implantation have a high rate of mortality & worse baseline & follow-up RV-GLS (but not LV-GLS) are independently associated with long-term mortality. No causality between post PPM/ICD TR & mortality is established & there is need for prospective confirmation.
Author Disclosures: A. Alashi: None. A. Abdallah: None. A. Mentias: None. M. Kanj: None. O. Wazni: None. B. Lindsay: None. Z.B. Popovic: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2016 by American Heart Association, Inc.