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This study sought to identify the feasibility of evaluating the factors that worsen Lead-induced tricuspid regurgitation (LITR) and quantify tricuspid regurgitation severity by Real-time three-Dimensional echocardiography (RT-3DE).
The subjects were a cohort of 128 consecutive patients who had cardiac devices implanted at the First Affiliated Hospital of Kunming Medical University Cardiovascular Department from October 2016 to March 2017. Conventional two-dimensional echocardiography (2DE) measures were performed and Real-time 3-Dimensional echocardiography were conducted to identify the relative anatomical location of implantable cardiac device lead and tricuspid using an GE Vivid E9 equipped with M5S and 4V transducer and digital loops were stored and analyzed offline with Echo PAC software.
One hundred and twenty-eight patients were enrolled, including 58 males and 70 females, mean age (57.22±15.93) years. The device leads position was evaluated at the tricuspid annular level using RT-3DE. Among the Interfering lead group: the lead impinged on the P leaflet in 10 patients, impinged on the S leaflet in 35 patients and impinged on the A leaflet in 4 patients, Among the Noninterfering lead group: the device leads were located in the commissure of two leaflets, the majority of the leads were in PS (n=37), 6 leads were in AS and 5 leads were in AP, 24 patients showed device leads in the middle of the tricuspid orifice. Using a multivariate stepwise logistic regression analysis, the presence of an interfering lead was the only factor associated with TR worsening OR=8.863 (95% CI: 3.639-21.585; p=0.001). The cutoff for 3D VCA was 0.55cm2 with sensitivity of 82% and specificity of 88% in predicting severe TR.
RT-3DE can straightforward visualize tricuspid valves on one plane simultaneously, which facilitate identifying the mechanism of Lead-induced tricuspid regurgitation (LITR) and quantify tricuspid regurgitation severity.