The Clinical Impact of Device Lead–Associated Tricuspid Regurgitation: Need for a Multidisciplinary Approach

Vij, Aviral; Kavinsky, Clifford J.

doi:10.1161/circulationaha.121.055019

Cited by 12 publications

(5 citation statements)

References 5 publications

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“…Regarding the serological markers, the BNP levels decreased by more than a half, from 901.7 pg/mL on the 1st tion of device lead varies from 10% to 39%. 18 In this case, quantitative method demonstrated no significant difference in degree of TR during…”

Section: Case Presentationmentioning

confidence: 65%

“…However, device lead‐associated TR is a matter of concern which refers to TR resulting from direct trauma or further interaction of the device leads. The incidence of new or worsening of TR after the implantation of device lead varies from 10% to 39% 18 . In this case, quantitative method demonstrated no significant difference in degree of TR during short follow‐up, which maybe due to extra leads not causing worsening of malcoaptation and regurgitation of TV, or improvement of cardiac function and PASP resulting in decreasing severity of secondary TR.…”

Section: Discussionmentioning

confidence: 99%

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Use of cardiac contractility modulation combined with left bundle branch pacing CRT‐P in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy: A case report

Fang,

Ma,

et al. 2024

Echocardiography

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Cardiac contractility modulation (CCM) is a novel device‐based therapy used to treat patients with heart failure with reduced ejection fraction (HFrEF). In both randomized clinical trials and real‐life studies, CCM has been shown to improve exercise tolerance and quality of life, reverse left ventricular remodeling, and reduce hospitalization in patients with HFrEF. In this case report, we describe for the first time the use of CCM combined with left bundle branch pacing (LBBP) cardiac resynchronization therapy pacemaker (CRT‐P) implantation therapy in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy. With the optimal medical therapy and cardiac resynchronization therapy (CRT) strategies, the patient's quality of life initially recovered to some extent, but began to deteriorate in the past year. Additionally, heart transplantation was not considered due to economic reasons and late stage systolic heart failure. This is the first case of CCM implantation in Fujian Province and the first report of a combined CCM and left bundle branch pacing CRT‐P implantation strategy in a patient with non‐ischemic etiology dilated cardiomyopathy in China.

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Section: Case Presentationmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Use of cardiac contractility modulation combined with left bundle branch pacing CRT‐P in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy: A case report

Fang,

Ma,

et al. 2024

Echocardiography

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“…This approach may have failed to exclude patients with lead‐associated TR who were not evaluated by 3‐dimensional transesophageal echocardiography or 3‐dimensional TTE, or patients with TR who initially had device lead–associated TR but eventually became lead independent. 43 Finally, the end point of this study was all‐cause mortality, and the cause of death was partially unknown. The association between cancer, which could be a potential cause of death, and mortality has not been conclusively established.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation

Ogawa,

Kuwajima,

Yamane

et al. 2024

JAHA

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Background The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. Methods and Results We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All‐cause death at 2‐year follow‐up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all‐cause death than those without by Kaplan–Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. Conclusions Elevated RAP and RVFWLS of ≤18% were independent predictors of all‐cause death. The combination of elevated RAP and RVFWLS effectively stratified the all‐cause death.

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“…Pacemaker/ICD leads represent a significant iatrogenic cause of tricuspid regurgitation [16]. Such leads may become adherent to the septal or posterior leaflets, resulting in significant posteroseptal commissural tricuspid regurgitation, which is often not amenable to a clip-based strategy.…”

Section: Anatomy-related Factorsmentioning

confidence: 99%

Which lesions are not amenable to tricuspid clipping?

Bakar,

Fam

2023

Current Opinion in Cardiology

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Purpose of review Tricuspid transcatheter edge-to-edge repair (T-TEER) has emerged as a well tolerated and effective therapeutic option for many patients with symptomatic severe tricuspid regurgitation at prohibitive surgical risk. However, there remain several important limitations to clip-based technology in the context of other rapidly emerging percutaneous treatment options for tricuspid regurgitation. Recent findings Tricuspid lesions pose unique challenges to treatment with the current toolbox of transcatheter clip-based technologies. This review will explore key issues related to patient factors, anatomical factors, and imaging factors that may render lesions to be unsuitable for treatment with T-TEER. Summary Selection for T-TEER must include a detailed clinical evaluation in the context of a ‘heart team’ approach involving multiple subspecialists, with screening for patient/lesion characteristics that make T-TEER suboptimal with current clip-based technologies. Future directions for research include patient-specific 3D modeling techniques, leaflet grasping techniques, clip deployment strategies, and personalized device sizing to increase the spectrum of lesions that may be treated with T-TEER within the context of other emerging transcatheter treatment options.

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The Clinical Impact of Device Lead–Associated Tricuspid Regurgitation: Need for a Multidisciplinary Approach

Cited by 12 publications

References 5 publications

Use of cardiac contractility modulation combined with left bundle branch pacing CRT‐P in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy: A case report

Use of cardiac contractility modulation combined with left bundle branch pacing CRT‐P in a female with a 22‐year history of non‐ischemic dilated cardiomyopathy: A case report

Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation

Which lesions are not amenable to tricuspid clipping?

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