SPC365

Predictors of mortality in a Lead-Related Tricuspid Regurgitation population – Is the Right Ventricle the Key?

Session: SESSÃO DE POSTERS 31 - VALVULOPATIA MITRAL E TRICÚSPIDE - DIAGNÓSTICO E INTERVENÇÃO VALVULAR
Speaker: João Mendes Cravo

Congress: CPC 2025
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Cartazes
FP Number: ---
Authors: João Mendes Cravo; Catarina Gregório; Joana Rigueira; Marta Vilela; Pedro Alves Silva; Daniel Caldeira; Rui Plácido; Fausto J.Pinto; Catarina Sousa

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>The hemodynamic effects of<strong> </strong>cardiac implantable electronic device (CIED) related tricuspid regurgitation (TR), in the right heart chambers is already established. Continuous volume overload leads to right ventricle (RV) adverse remodeling with dilation/dysfunction. Our study aimed to identify predictors of development of severe lead-related TR and assess if development of RV dysfunction has a prognostic impact.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong>Pre/post procedural echocardiographic data was collected in patients (pts) submitted to CIED implantation in the prior 10 years. Only pts who fulfilled criteria for lead-related TR were included. Predictors for development of severe lead-related TR were evaluated. The impact of severe TR and RV dysfunction on the composite outcome (admission for heart failure, time to first urgent care visit and death) was evaluated with Kaplan&ndash;Meier estimates and Cox proportional-hazards mode with multivariable analysis. A Forest Plot was constructed to visually represent these results.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong>We included 68 pts, 57% male, mean age 77 years. 34 pts (50%) developed severe TR after CIED implantation, and 37 (54%) developed RV dysfunction. The mean TAPSE was 18.5mm, mean right atrium area was 20cm<sup>2</sup> and median LV ejection fraction was 54%. Median follow-up time was 8.4 years.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On univariate analysis we observed that an increase in the QRS interval of 1 ms was associated with a 2% increased risk of developing severe related TR. Baseline TAPSE was inversely associated with the risk of developing severe related TR, and the effect was consistent after adjusting for other variables (OR 0.701, 95%</span></span><span style="font-family:Symbol"><span style="color:#000000">[</span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CI], 0.555-0.885, p=0.003).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">At follow-up severe TR was associated with an increased risk for unplanned urgent care visit for heart failure (HF) (HR 4.667, 95% </span></span><span style="font-family:Symbol"><span style="color:#000000">[</span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CI] 1.540-14.143, p=0.005) and HF hospitalization (HR 5.510, 95% </span></span><span style="font-family:Symbol"><span style="color:#000000">[</span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CI] 1.879-16.159, p=0.001).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Development of RV dysfunction was associated with increased risk for a composite outcome of CV death, hospitalization/unplanned urgent care visits for HF on univariate analysis. It remained an independent predictor of CV mortality after adjusting for other factors: age, gender, device, NYHA class, Ejection Fraction (HR 8.199, 95% </span></span><span style="font-family:Symbol"><span style="color:#000000">[</span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000">CI] 1.033-65.092, p=0.047).&nbsp;</span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:16px"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong>In a patient population with lead-related TR, severe TR and development RV dysfunction are strongly associated with adverse cardiovascular outcomes. Our work highlights the role of RV function and CIED-related TR severity in determining prognosis and the need for close monitoring of this population.</span></span></span></p>