Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/37292
Title: Tricuspid regurgitation after cardiac resynchronization therapy: evolution and prognostic significance
Authors: STASSEN, Jan 
Galloo, Xavier
Hirasawa, Kensuke
Marsan, Nina Ajmone
van der Bijl, Pieter
Delgado, Victoria
Bax, Jeroen J.
Issue Date: 2022
Publisher: OXFORD UNIV PRESS
Source: EUROPACE, MAR 2022
Status: Early view
Abstract: Aims Tricuspid regurgitation (TR) is common in patients with heart failure (HF) and is associated with worse outcome. This study investigated the effect of cardiac resynchronization therapy (CRT) on TR severity and long-term outcome. Methods and results Tricuspid regurgitation severity was assessed at baseline and 6 months after CRT implantation, using a multiparametric approach. Patients were divided into four groups: (i) no or mild TR without progression; (ii) no or mild TR with progression to significant (moderate-severe) TR; (iii) significant TR with improvement to no or mild TR; and (iv) significant TR without improvement. The primary endpoint was all-cause mortality. A total of 852 patients (mean age 65 +/- 11 years, 77% male) were included. At baseline, 184 (22%) patients had significant TR, with 75 (41%) showing significant improvement at 6-month follow-up. After a median follow-up of 92 (50-137) months, 494 (58%) patients died. Patients with significant TR showing improvement at follow-up had better outcomes than those showing no improvement (P = 0.016). On multivariable analysis, no or mild TR progressing to significant TR [hazard ratio (HR) 1.745; 95% confidence interval (CI): 1.287-2.366; P < 0.001] and significant TR without improvement (HR 1.572; 95% CI: 1.198-2.063; P = 0.001) were independently associated with all-cause mortality, whereas significant TR with improvement at follow-up was not (HR: 1.153; 95% CI: 0.814-1.633; P = 0.424). Conclusion Improvement of significant TR after CRT is observed in a substantial proportion of patients, highlighting the potential benefit of CRT for patients with HF having significant TR. Significant TR at 6 months after CRT is independently associated with increased long-term mortality.
Notes: Bax, JJ (corresponding author), Leiden Univ Med Ctr, Dept Cardiol, Albinusdreef 2, NL-2300 RC Leiden, Netherlands.; Bax, JJ (corresponding author), Univ Turku, Turku Heart Ctr, Dept Cardiol, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland.; Bax, JJ (corresponding author), Turku Univ Hosp, Kiinamyllynkatu 4-8, FI-20520 Turku, Finland.
j.j.bax@lumc.nl
Keywords: Cardiac resynchronization therapy; Tricuspid regurgitation; Heart;failure; Mortality; Outcome; Prognosis
Document URI: http://hdl.handle.net/1942/37292
ISSN: 1099-5129
e-ISSN: 1532-2092
DOI: 10.1093/europace/euac034
ISI #: WOS:000785605500001
Category: A1
Type: Journal Contribution
Appears in Collections:Research publications

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