title: Effects of tricuspid valve regurgitation on outcome in patients with cardiac resynchronization therapy.
abstract: Cardiac resynchronization therapy (CRT) has a symptomatic and survival benefit for patients with heart failure (HF), but the percentage of nonresponders remains relatively high. The aims of this study were to assess the clinical significance of baseline tricuspid regurgitation (TR) or worsening TR after implantation of a CRT device on the response to therapy. This is a multicenter retrospective analysis of prospectively collected databases that includes 689 consecutive patients who underwent implantation of CRT. The patients were divided into groups according to baseline TR grade and according to worsening TR within 15 months after device implantation. Outcome was assessed by clinical and echocardiographic response within 15 months and by estimated survival for a median interquartile range follow-up time of 3.3 years (1.6, 4.6). TR worsening after CRT implantation was documented in 104 patients (15%). These patients had worse clinical and echocardiographic response to CRT, but worsening of TR was not a significant predictor of mortality (p = 0.17). According to baseline echocardiogram, 620 patients (90%) had some degree of TR before CRT implant. Baseline TR was an independent predictor of worse survival (p <0.001), although these patients had significantly better clinical and echocardiographic response compared with patients without TR. In conclusion, worsening of TR after CRT implantation is a predictor of worse clinical and echocardiographic response but was not significantly associated with increased mortality. Baseline TR is associated with reduced survival despite better clinical and echocardiographic response after CRT implantation.
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel. Electronic address: grupper.avishay@mayo.edu.
authors: Avishay
authors: A
authors: Grupper
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Ammar M
authors: AM
authors: Killu
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Paul A
authors: PA
authors: Friedman
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Raed
authors: R
authors: Abu Sham'a
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Jonathan
authors: J
authors: Buber
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Rafael
authors: R
authors: Kuperstein
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Guy
authors: G
authors: Rozen
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Samuel J
authors: SJ
authors: Asirvatham
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Raul E
authors: RE
authors: Espinosa
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: David
authors: D
authors: Luria
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Tracy L
authors: TL
authors: Webster
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Kelly L
authors: KL
authors: Brooke
authors: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors: David O
authors: DO
authors: Hodge
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Heather J
authors: HJ
authors: Wiste
authors: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
authors: Yong-Mei
authors: YM
authors: Cha
authors: Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
authors: Michael
authors: M
authors: Glikson
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D007557:Israel; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D014463:Ultrasonography