A Research Of Incidence And Predictors Of Tricuspid Regurgitation In Patients With Pacemaker Implantation By Transthoracic Echocardiography

Objective To compare the basic clinical information and echocardiography characteristics in patients before and after pacemaker implantation admitted in the hospital,to explore the incidence and predictors of the lead-induced tricuspid regurgitation(LITR)after implantation,and to assess the value of transthoracic echocardiography.Methods 137 patients underwent pacemaker implantation in the first affiliated hospital of Guangxi medical university from January 2000 to October 2018 were carefully reviewed,who were suffering from sick sinus node syndrome(SSS)or atrioventricular block(AVB),and were implanted with Dual-chamber pacing(DDD)or Single ventricular pacing(VVI)pacemaker.Echocardiographic examinations were performed before and after the pacemaker implantation admitted in the hospital.The basic clinical data and echocardiographic characteristics of the 137 patients were analyzed retrospectively.According to the final grades of TR of patients,the patients were divided into two groups: non-significant TR group and significant TR group.Predictors of significant TR after pacemaker implantation of the two groups were analyzed by multivariable Logistic Regression Model.Results1.The mean follow-up duration of the study population was(7.0±2.9)years.119 patients(87%)developed non-TR or Mild TR during the follow-up(defined as non-significant TR group),18 patients(13%)developed moderate TR or severe TR during the follow-up(defined as significant TR group).2.In the univariate analysis,compared the significant TR group with the non-significant TR group,the age,gender,body mass index were not statistically significant(P>0.05).A previous history of sick sinus node syndrome or atrioventricular block,hypertension,diabetes,coronary heart disease,together with DDD or VVI,pacing sites were not statistically significant(P > 0.05).The significant TR group had longer follow-up period and developed higher prevalence of moderate to severe mitral valve regurgitation(P < 0.05).For the pre-implantation evaluation,the significant TR group had larger size of right atrial diameter,right ventricular end diastolic diameter,higher prevalence of pre-existing mild TR and higher prevalence of pre-existing atrial fibrillation(P < 0.05).The left atrial anterior-posterior diameter,left ventricular end diastolic dimension,left ventricular end systolic dimension,left ventricular ejection fraction,left ventricular fractional shortening,right ventricular outflow tract,prevalence of pre-existing mild MR and prevalence of pre-existing mild AR were not statistically significant(P>0.05).3.To identify the independent predictors of significant LITR,we established multivariable Logistic Regression Model.LITR is associated with pre-existing atrial fibrillation,larger size of right atrial diameter,larger size of right ventricular end diastolic diameter,pre-existing mild TR and longer follow-up period.The independent predictors of significant LITR were prevalence of pre-existing atrial fibrillation(OR 6.578,95%CI 1.683-25.713,P = 0.007)and size of right atrial diameter(OR 1.231,95%CI 1.072-1.413,P = 0.003).Conclusion 1.Pacemaker implantation can effect on TR.2.Pre-existing atrial fibrillation and larger size of right atrial diameter are the independent predictors of the present of TR.3.Transthoracic echocardiography plays an important role in cardiac evaluation before and after implantation.