Progressive tricuspid regurgitation and elevated pressure gradient after transvenous permanent pacemaker implantation

Abstract

Background: The association of postimplant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear.

Hypothesis: This study aimed to explore the clinical outcomes of progressive postimplant TR after permanent pacemaker (PPM) implantation.

Methods: A total of 1670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, history of HF, and baseline abnormal TR and TRPG were excluded. Finally, a total of 1075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and TRPG of >30 mmHg after implant.

Results: In 198 (18.4%) patients (group 1) experienced progressive postimplant TR and elevated TRPG, whereas 877 patients (group 2) did not have progressive postimplant TR. Group 1 had larger change in postimplant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < .001) than group 2. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < .001). Preimplant TRPG (HR: 1.075; 95% confidence interval [CI]: 1.032-1.121; p = .001) was an independent predictor of progressive postimplant TR.

Conclusions: After a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive postimplant TR and elevated TRPG. Higher preimplant TRPG was an independent predictor of progressive postimplant TR.

Keywords: heart failure hospitalization; transvenous permanent pacemaker implantation; tricuspid regurgitation.

FIGURE 1

(A) Changes of the tricuspid regurgitation pressure gradient in group 1. In group 1, the postimplant TRPG was significantly higher than preimplant TRPG (p < .001). (B) The cumulative incident rate of progressive postimplant tricuspid regurgitation. The cumulative rate of progressive postimplant TR increased from 1.3% in the first year to 18.4% in the sixth year. (C) A Kaplan–Meier curve analysis for heart failure hospitalization. Group 1 (with progressive postimplant tricuspid regurgitation and elevated tricuspid regurgitation pressure gradient) had a significantly higher incidence of heart failure hospitalization compared to group 2 (without progressive postimplant tricuspid regurgitation and elevated tricuspid regurgitation pressure gradient) (log‐rank p < .001)