植入式经静脉装置导线位置对三尖瓣反流严重程度的影响。
Impact of implantable transvenous device lead location on severity of tricuspid regurgitation.
作者信息
Addetia Karima, Maffessanti Francesco, Mediratta Anuj, Yamat Megan, Weinert Lynn, Moss Joshua D, Nayak Hemal M, Burke Martin C, Patel Amit R, Kruse Eric, Jeevanandam Valluvan, Mor-Avi Victor, Lang Roberto M
机构信息
Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
出版信息
J Am Soc Echocardiogr. 2014 Nov;27(11):1164-75. doi: 10.1016/j.echo.2014.07.004. Epub 2014 Aug 14.
BACKGROUND
Implantable device leads can cause tricuspid regurgitation (TR) when they interfere with leaflet motion. The aim of this study was to determine whether lead-leaflet interference is associated with TR severity, independent of other causative factors of functional TR.
METHODS
A total of 100 patients who underwent transthoracic two-dimensional and three-dimensional (3D) echocardiography of the tricuspid valve before and after lead placement were studied. Lead position was classified on 3D echocardiography as leaflet-interfering or noninterfering. TR severity was estimated by vena contracta (VC) width. Logistic regression analysis was used to identify factors associated with postdevice TR, including predevice VC width, right ventricular end-diastolic and end-systolic areas, fractional area change, right atrial size, tricuspid annular diameter, TR gradient, device lead age, and presence or absence of lead interference. Odds ratios were used to describe the association with moderate (VC width ≥ 0.5 cm) or severe (VC width ≥ 0.7 cm) TR, separately, using bivariate and stepwise multivariate logistic regression analysis.
RESULTS
Forty-five of 100 patients showed device lead tricuspid valve leaflet interference. The septal leaflet was the most commonly affected (23 patients). On bivariate analysis, preimplantation VC width, right atrial size, tricuspid annular diameter, and lead-leaflet interference were significantly associated with postdevice TR. On multivariate analysis, preimplantation VC width and the presence of an interfering lead were independently associated with postdevice TR. Furthermore, the presence of an interfering lead was the only factor associated with TR worsening, increasing the likelihood of developing moderate or severe TR by 15- and 11-fold, respectively.
CONCLUSION
Lead-leaflet interference as seen on 3D echocardiography is associated with TR after device lead placement, suggesting that 3D echocardiography should be used to assess for lead interference in patients with significant TR.
背景
植入式设备导线在干扰瓣叶运动时可导致三尖瓣反流（TR）。本研究的目的是确定导线与瓣叶的干扰是否与TR严重程度相关，而不受功能性TR其他致病因素的影响。
方法
对100例在导线植入前后接受经胸二维和三维（3D）三尖瓣超声心动图检查的患者进行研究。在3D超声心动图上，将导线位置分类为干扰瓣叶或不干扰瓣叶。通过缩流颈（VC）宽度评估TR严重程度。采用逻辑回归分析确定与设备植入后TR相关的因素，包括植入前VC宽度、右心室舒张末期和收缩末期面积、面积变化分数、右心房大小、三尖瓣环直径、TR压差、设备导线使用年限以及是否存在导线干扰。使用比值比分别通过双变量和逐步多变量逻辑回归分析来描述与中度（VC宽度≥0.5 cm）或重度（VC宽度≥0.7 cm）TR的关联。
结果
100例患者中有45例显示设备导线干扰三尖瓣瓣叶。隔叶是最常受影响的（23例患者）。双变量分析显示，植入前VC宽度、右心房大小、三尖瓣环直径和导线与瓣叶的干扰与设备植入后TR显著相关。多变量分析显示，植入前VC宽度和存在干扰导线与设备植入后TR独立相关。此外，存在干扰导线是与TR恶化相关的唯一因素，分别使发生中度或重度TR的可能性增加15倍和11倍。
结论
3D超声心动图上显示的导线与瓣叶的干扰与设备导线植入后的TR相关，提示对于有显著TR的患者，应使用3D超声心动图评估导线干扰情况。
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