Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads
Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies, or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM)...
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| Veröffentlicht in: | The American journal of cardiology 2016-03, Vol.117 (6), p.988-992 |
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| creator | Delling, Francesca N., MD Hassan, Zena K., MD Piatkowski, Gail, BSBC Tsao, Connie W., MD Rajabali, Alefiyah, MD Markson, Lawrence J., MD, MPH Zimetbaum, Peter J., MD Manning, Warren J., MD Chang, James D., MD Mukamal, Kenneth J., MD |
| description | Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies, or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥3+) among all echocardiograms performed from 2005 to 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular systolic/diastolic function, and pulmonary artery hypertension. We screened 93,592 echocardiograms (1,245 with PPM) in 58,556 individual patients (634 with PPM). The prevalence of STR was higher in patients after PPM placement (mean age 79 ± 3 years; 54% men) compared with those without a PPM (adjusted odds ratio 2.32; 95% confidence interval [CI] 1.54 to 3.49; p 58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for left ventricular systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality. |
| doi_str_mv | 10.1016/j.amjcard.2015.12.038 |
| format | Article |
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We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥3+) among all echocardiograms performed from 2005 to 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular systolic/diastolic function, and pulmonary artery hypertension. We screened 93,592 echocardiograms (1,245 with PPM) in 58,556 individual patients (634 with PPM). The prevalence of STR was higher in patients after PPM placement (mean age 79 ± 3 years; 54% men) compared with those without a PPM (adjusted odds ratio 2.32; 95% confidence interval [CI] 1.54 to 3.49; p <0.0001). Among patients with a PPM lead, the presence of STR was associated with increased mortality (adjusted hazard ratio 1.40; 95% CI 1.04 to 2.11, p = 0.027, vs no STR). Compared with having neither a PPM lead nor STR, adjusted hazard ratios for death were 2.13 (95% CI 1.93 to 2.34) for STR but no PPM, 1.04 (0.89 to 1.22) for PPM without STR, and 1.55 (1.13 to 2.14) for PPM with STR. In conclusion, in a sample comprising >58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for left ventricular systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2015.12.038</identifier><identifier>PMID: 26833208</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Body mass index ; Cardiology ; Cardiovascular ; Defibrillators, Implantable - adverse effects ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart attacks ; Humans ; Longitudinal Studies ; Male ; Mortality ; Pacemaker, Artificial - adverse effects ; Prevalence ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Tricuspid Valve Insufficiency - diagnostic imaging ; Tricuspid Valve Insufficiency - mortality ; United States - epidemiology</subject><ispartof>The American journal of cardiology, 2016-03, Vol.117 (6), p.988-992</ispartof><rights>Elsevier Inc.</rights><rights>2016 Elsevier Inc.</rights><rights>Copyright © 2016 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Mar 15, 2016</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c550t-13a108585d9ea5d390796ae95c4d98051838dc8c9a71aae9598cf749c26e6b133</citedby><cites>FETCH-LOGICAL-c550t-13a108585d9ea5d390796ae95c4d98051838dc8c9a71aae9598cf749c26e6b133</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914915300837$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26833208$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Delling, Francesca N., MD</creatorcontrib><creatorcontrib>Hassan, Zena K., MD</creatorcontrib><creatorcontrib>Piatkowski, Gail, BSBC</creatorcontrib><creatorcontrib>Tsao, Connie W., MD</creatorcontrib><creatorcontrib>Rajabali, Alefiyah, MD</creatorcontrib><creatorcontrib>Markson, Lawrence J., MD, MPH</creatorcontrib><creatorcontrib>Zimetbaum, Peter J., MD</creatorcontrib><creatorcontrib>Manning, Warren J., MD</creatorcontrib><creatorcontrib>Chang, James D., MD</creatorcontrib><creatorcontrib>Mukamal, Kenneth J., MD</creatorcontrib><title>Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies, or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥3+) among all echocardiograms performed from 2005 to 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular systolic/diastolic function, and pulmonary artery hypertension. We screened 93,592 echocardiograms (1,245 with PPM) in 58,556 individual patients (634 with PPM). The prevalence of STR was higher in patients after PPM placement (mean age 79 ± 3 years; 54% men) compared with those without a PPM (adjusted odds ratio 2.32; 95% confidence interval [CI] 1.54 to 3.49; p <0.0001). Among patients with a PPM lead, the presence of STR was associated with increased mortality (adjusted hazard ratio 1.40; 95% CI 1.04 to 2.11, p = 0.027, vs no STR). Compared with having neither a PPM lead nor STR, adjusted hazard ratios for death were 2.13 (95% CI 1.93 to 2.34) for STR but no PPM, 1.04 (0.89 to 1.22) for PPM without STR, and 1.55 (1.13 to 2.14) for PPM with STR. In conclusion, in a sample comprising >58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for left ventricular systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Body mass index</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Defibrillators, Implantable - adverse effects</subject><subject>Echocardiography</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Mortality</subject><subject>Pacemaker, Artificial - adverse effects</subject><subject>Prevalence</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Survival Rate</subject><subject>Tricuspid Valve Insufficiency - diagnostic imaging</subject><subject>Tricuspid Valve Insufficiency - mortality</subject><subject>United States - epidemiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkk1v1DAQhi0EotvCTwBF4sIlwRPHjn0pqiq-pEVUsIgLkuXas1un-VjsZKX993W0S4FeOFmeeWY8r98h5AXQAiiIN01husaa4IqSAi-gLCiTj8gCZK1yUMAekwWltMwVVOqEnMbYpCsAF0_JSSkkYyWVC_JzFbyd4ta77CtuprDxoxn90Gemd9nnIYym9eM-8312leLYjzH74cebbBVMH3fYD1PMrjB0pk-5xFjszC2GbInGxWfkydq0EZ8fzzPy_f271eXHfPnlw6fLi2VuOadjDswAlVxyp9BwxxStlTCouK2ckpSDZNJZaZWpwcxxJe26rpQtBYprYOyMnB_6bqfrDp1NowTT6m3wnQl7PRiv_830_kZvhp2u6pqzElKD18cGYfg1YRx156PFtk2ykkINtVACVFWJhL56gDbDFPokb6Ykr6QUVaL4gbJhiDHg-n4YoHr2Tzf66J-e_dNQ6uRfqnv5t5L7qt-GJeDtAcD0nzuPQUebbLHofEA7ajf4_z5x_qCDbX3vrWlvcY_xjxodU4H-Ni_RvEPAGU0D1OwOBNfEZQ</recordid><startdate>20160315</startdate><enddate>20160315</enddate><creator>Delling, Francesca N., MD</creator><creator>Hassan, Zena K., MD</creator><creator>Piatkowski, Gail, BSBC</creator><creator>Tsao, Connie W., MD</creator><creator>Rajabali, Alefiyah, MD</creator><creator>Markson, Lawrence J., MD, MPH</creator><creator>Zimetbaum, Peter J., MD</creator><creator>Manning, Warren J., MD</creator><creator>Chang, James D., MD</creator><creator>Mukamal, Kenneth J., MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160315</creationdate><title>Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads</title><author>Delling, Francesca N., MD ; Hassan, Zena K., MD ; Piatkowski, Gail, BSBC ; Tsao, Connie W., MD ; Rajabali, Alefiyah, MD ; Markson, Lawrence J., MD, MPH ; Zimetbaum, Peter J., MD ; Manning, Warren J., MD ; Chang, James D., MD ; Mukamal, Kenneth J., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c550t-13a108585d9ea5d390796ae95c4d98051838dc8c9a71aae9598cf749c26e6b133</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Body mass index</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Defibrillators, Implantable - adverse effects</topic><topic>Echocardiography</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Mortality</topic><topic>Pacemaker, Artificial - adverse effects</topic><topic>Prevalence</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Survival Rate</topic><topic>Tricuspid Valve Insufficiency - diagnostic imaging</topic><topic>Tricuspid Valve Insufficiency - mortality</topic><topic>United States - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Delling, Francesca N., MD</creatorcontrib><creatorcontrib>Hassan, Zena K., MD</creatorcontrib><creatorcontrib>Piatkowski, Gail, BSBC</creatorcontrib><creatorcontrib>Tsao, Connie W., MD</creatorcontrib><creatorcontrib>Rajabali, Alefiyah, MD</creatorcontrib><creatorcontrib>Markson, Lawrence J., MD, MPH</creatorcontrib><creatorcontrib>Zimetbaum, Peter J., MD</creatorcontrib><creatorcontrib>Manning, Warren J., MD</creatorcontrib><creatorcontrib>Chang, James D., MD</creatorcontrib><creatorcontrib>Mukamal, Kenneth J., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Delling, Francesca N., MD</au><au>Hassan, Zena K., MD</au><au>Piatkowski, Gail, BSBC</au><au>Tsao, Connie W., MD</au><au>Rajabali, Alefiyah, MD</au><au>Markson, Lawrence J., MD, MPH</au><au>Zimetbaum, Peter J., MD</au><au>Manning, Warren J., MD</au><au>Chang, James D., MD</au><au>Mukamal, Kenneth J., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2016-03-15</date><risdate>2016</risdate><volume>117</volume><issue>6</issue><spage>988</spage><epage>992</epage><pages>988-992</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Estimates of the prevalence and importance of significant tricuspid regurgitation (STR) related to implantable device leads are based mainly on case reports, small observational studies, or mixed samples that include defibrillators. We sought to assess whether patients with permanent pacemaker (PPM) leads have an increased risk of STR and to determine mortality associated with PPM-related TR in a large longitudinal single-center cohort. We examined the prevalence of STR (defined as moderate-severe or ≥3+) among all echocardiograms performed from 2005 to 2011 excluding those with defibrillators. We then examined mortality risk according to the prevalence of PPM and STR after adjusting for cardiac co-morbidities, left ventricular systolic/diastolic function, and pulmonary artery hypertension. We screened 93,592 echocardiograms (1,245 with PPM) in 58,556 individual patients (634 with PPM). The prevalence of STR was higher in patients after PPM placement (mean age 79 ± 3 years; 54% men) compared with those without a PPM (adjusted odds ratio 2.32; 95% confidence interval [CI] 1.54 to 3.49; p <0.0001). Among patients with a PPM lead, the presence of STR was associated with increased mortality (adjusted hazard ratio 1.40; 95% CI 1.04 to 2.11, p = 0.027, vs no STR). Compared with having neither a PPM lead nor STR, adjusted hazard ratios for death were 2.13 (95% CI 1.93 to 2.34) for STR but no PPM, 1.04 (0.89 to 1.22) for PPM without STR, and 1.55 (1.13 to 2.14) for PPM with STR. In conclusion, in a sample comprising >58,000 individual patients, PPM leads are associated with higher risk of STR after adjustment for left ventricular systolic/diastolic function and pulmonary artery hypertension; similarly to STR from other cardiac pathologies, PPM-related STR is associated with increased mortality.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26833208</pmid><doi>10.1016/j.amjcard.2015.12.038</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Body mass index Cardiology Cardiovascular Defibrillators, Implantable - adverse effects Echocardiography Echocardiography, Transesophageal Female Heart attacks Humans Longitudinal Studies Male Mortality Pacemaker, Artificial - adverse effects Prevalence Risk Factors Severity of Illness Index Survival Rate Tricuspid Valve Insufficiency - diagnostic imaging Tricuspid Valve Insufficiency - mortality United States - epidemiology |
| title | Tricuspid Regurgitation and Mortality in Patients With Transvenous Permanent Pacemaker Leads |
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