Cho Min Soo, Kim Jun, Lee Jung-Bok, Nam Gi-Byoung, Choi Kee-Joon, Kim You-Ho
Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Division of Biostatistics, Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Pacing Clin Electrophysiol. 2019 Jan;42(1):85-92. doi: 10.1111/pace.13543. Epub 2018 Nov 29.
The incidence and predictors of tricuspid regurgitation (TR) after permanent pacemaker (PM) implantations have not been well evaluated. We attempted to determine TR's natural course and predictors, especially focusing on the influence of atrial fibrillation (AF).
Data from 530 patients with dual-chamber PMs were evaluated. The main study outcomes were moderate to severe TR and isolated TR (moderate to severe TR without other structural heart diseases [SHDs]) in follow-up echocardiography.
Over a median follow-up period of 7.6 years, moderate to severe TR developed in 14.5% patients. Of those, concomitant SHD was observed in 51.9% of patients, and 48.1% presented with isolated TR. A multivariable analysis identified the independent predictors of moderate to severe TR (diabetes mellitus [DM], chronic lung disease, preexisting mild TR, peripheral artery disease, moderate to severe aortic regurgitation, and persistent AF [PeAF]) and isolated TR (DM, preexisting mild TR, and PeAF). PeAF (n = 67, 12.6%) was an independent predictor of both moderate to severe TR (hazard ratio [HR] 2.59, 95% confidence interval [CI]: 1.22-5.51) and isolated TR (HR 4.54, 95% CI: 1.60-12.90). The patients with PeAF exhibited a higher incidence of moderate to severe TR (21.8% vs 12.9% vs 11.6% PeAF, paroxysmal AF, and without AF, respectively) and isolated TR (18.6% vs 6.6% vs 4.2%, respectively) during the follow-up.
Moderate to severe TR after PM implantations developed with or without the influence of concomitant SHD. Patients with PeAF exhibited a higher risk of moderate to severe TR after PM implantations.
永久起搏器（PM）植入术后三尖瓣反流（TR）的发生率及预测因素尚未得到充分评估。我们试图确定TR的自然病程及预测因素，尤其关注心房颤动（AF）的影响。
对530例双腔PM患者的数据进行评估。主要研究结局为随访超声心动图检查中的中重度TR和孤立性TR（无其他结构性心脏病[SHD]的中重度TR）。
在中位随访期7.6年期间，14.5%的患者发生了中重度TR。其中，51.9%的患者伴有SHD，48.1%表现为孤立性TR。多变量分析确定了中重度TR（糖尿病[DM]、慢性肺病、既往轻度TR、外周动脉疾病、中重度主动脉反流和持续性AF[PeAF]）和孤立性TR（DM、既往轻度TR和PeAF）的独立预测因素。PeAF（n = 67，12.6%）是中重度TR（风险比[HR] 2.59，95%置信区间[CI]：1.22 - 5.51）和孤立性TR（HR 4.54，95% CI：1.60 - 12.90）的独立预测因素。在随访期间，PeAF患者中重度TR（分别为21.8% vs 12.9% vs 11.6%，PeAF、阵发性AF和无AF患者）和孤立性TR（分别为18.6% vs 6.6% vs 4.2%）的发生率更高。
PM植入术后中重度TR的发生不受或受伴发SHD的影响。PeAF患者在PM植入术后发生中重度TR的风险更高。
