Author + information
- Giselle Adriana Baquero,
- Joshua B. Skibba,
- Pradeep Yadav,
- Javier E. Banchs,
- Latoya N. Linton-Frazier,
- Eugene J. Lengerich,
- Soraya M. Samii,
- Erica Penny-Peterson,
- Deborah L. Wolbrette,
- Gerald V. Naccarelli and
- Mario D. Gonzalez
Cardiac rhythm management devices (CRMD) require a ventricular lead to be placed across the tricuspid valve. Tricuspid valve incompetence and regurgitation (TR) has been an under-recognized clinical complication of ventricular lead implantation and its clinical significance is not fully known. We studied the incidence of hospitalizations for congestive heart failure exacerbation (CHFE) among patients that experienced worsening TR following a ventricular lead implantation.
We retrospectively reviewed 148 patients (age 68±15) that received a CRMD. TR and pulmonary artery systolic pressure (PASP) measured by Doppler echocardiography before and after CRT device implantation were analyzed. TR was graded on a scale from 0-4. Patients were classified according to the change in grade of TR after device implantation as follows: none (<1), mild (1), and moderate to severe (≥2). Hospitalizations for CHFE after device implantation were counted.
Patient groups were comparable with regards to baseline characteristics. Mean follow-up time was 32±14 months. One hundred (68%) patients had no change, 36 (24%) had mild and 12 (8%) moderate to severe increase in TR after CRMD implantation. Patients that experienced a moderate to severe change in TR had significantly higher incidence of hospitalizations (1.4±0.8) compared to patients that had mild (0.72±0.9) or no increase (0.5±1) in TR (p=<0.01). Patients with a moderate to severe increase in TR had a greater change in PASP (13mmHg; p=0.002) after device implantation compared to those with mild (4mmHg; p=0.02) or no increase in TR (0.8mmHg).
Increased TR following a CRMD implant is relatively common (48 out of 148 implants, 32%) and correlated with subsequent risk of hospitalization for heart failure. Certainly, lead related valve incompetence may contribute to worsening TR after CRMD implantation. The association between change in TR and change in PASP suggests that worsening of left heart function may further exacerbate valve incompetence after device implantation.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Heart Failure: Cardiac Resynchronization Therapy
Abstract Category: 17. Heart Failure: Therapy
Presentation Number: 1177-301
- 2013 American College of Cardiology Foundation