1
|
Yuyun MF, Joseph J, Erqou SA, Kinlay S, Echouffo-Tcheugui JB, Peralta AO, Hoffmeister PS, Boden WE, Yarmohammadi H, Martin DT, Singh JP. Evolution and prognosis of tricuspid and mitral regurgitation following cardiac implantable electronic devices: a systematic review and meta-analysis. Europace 2024; 26:euae143. [PMID: 38812433 PMCID: PMC11259857 DOI: 10.1093/europace/euae143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024] Open
Abstract
AIMS Significant changes in tricuspid regurgitation (TR) and mitral regurgitation (MR) post-cardiac implantable electronic devices (CIEDs) are increasingly recognized. However, uncertainty remains as to whether the risk of CIED-associated TR and MR differs with right ventricular pacing (RVP) via CIED with trans-tricuspid RV leads, compared with cardiac resynchronization therapy (CRT), conduction system pacing (CSP), and leadless pacing (LP). The study aims to synthesize extant data on risk and prognosis of significant post-CIED TR and MR across pacing strategies. METHODS AND RESULTS We searched PubMed, EMBASE, and Cochrane Library databases published until 31 October 2023. Significant post-CIED TR and MR were defined as ≥ moderate. Fifty-seven TR studies (n = 13 723 patients) and 90 MR studies (n = 14 387 patients) were included. For all CIED, the risk of post-CIED TR increased [pooled odds ratio (OR) = 2.46 and 95% CI = 1.88-3.22], while the risk of post-CIED MR reduced (OR = 0.74, 95% CI = 0.58-0.94) after 12 and 6 months of median follow-up, respectively. Right ventricular pacing via CIED with trans-tricuspid RV leads was associated with increased risk of post-CIED TR (OR = 4.54, 95% CI = 3.14-6.57) and post-CIED MR (OR = 2.24, 95% CI = 1.18-4.26). Binarily, CSP did not alter TR risk (OR = 0.37, 95% CI = 0.13-1.02), but significantly reduced MR (OR = 0.15, 95% CI = 0.03-0.62). Cardiac resynchronization therapy did not significantly change TR risk (OR = 1.09, 95% CI = 0.55-2.17), but significantly reduced MR with prevalence pre-CRT of 43%, decreasing post-CRT to 22% (OR = 0.49, 95% CI = 0.40-0.61). There was no significant association of LP with post-CIED TR (OR = 1.15, 95% CI = 0.83-1.59) or MR (OR = 1.31, 95% CI = 0.72-2.39). Cardiac implantable electronic device-associated TR was independently predictive of all-cause mortality [pooled hazard ratio (HR) = 1.64, 95% CI = 1.40-1.90] after median of 53 months. Mitral regurgitation persisting post-CRT independently predicted all-cause mortality (HR = 2.00, 95% CI = 1.57-2.55) after 38 months. CONCLUSION Our findings suggest that, when possible, adoption of pacing strategies that avoid isolated trans-tricuspid RV leads may be beneficial in preventing incident or deteriorating atrioventricular valvular regurgitation and might reduce mortality.
Collapse
Affiliation(s)
- Matthew F Yuyun
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Jacob Joseph
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, VA Providence Healthcare System, 830 Chalkstone Ave, Providence, RI 02908, USA
- Department of Medicine, Brown University, 1 Prospect Street, Providence, RI 02912, USA
| | - Sebhat A Erqou
- Department of Medicine, VA Providence Healthcare System, 830 Chalkstone Ave, Providence, RI 02908, USA
- Department of Medicine, Brown University, 1 Prospect Street, Providence, RI 02912, USA
| | - Scott Kinlay
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Justin B Echouffo-Tcheugui
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA
| | - Adelqui O Peralta
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Peter S Hoffmeister
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - William E Boden
- Department of Medicine, VA Boston Healthcare System, 1400 VFW Parkway, West Roxbury, MA 02132, USA
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, 72 E Concord St, Boston, MA 02118, USA
| | - Hirad Yarmohammadi
- Department of Medicine, Columbia University Irving Medical Center, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - David T Martin
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115, USA
| | - Jagmeet P Singh
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
| |
Collapse
|
2
|
Onishi H, Izumo M, Naganuma T, Nakamura S, Akashi YJ. Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future. Front Cardiovasc Med 2022; 9:883450. [PMID: 35548414 PMCID: PMC9081364 DOI: 10.3389/fcvm.2022.883450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/28/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is a challenging situation in healthcare worldwide. Secondary mitral regurgitation (SMR) is a common condition in HF patients with reduced ejection fraction (HFrEF) and tends to be increasingly associated with unfavorable clinical outcomes as the severity of SMR increases. It is worth noting that SMR can deteriorate dynamically under stress. Over the past three decades, the characteristics of dynamic SMR have been studied. Dynamic SMR contributes to the reduction in exercise capacity and adverse clinical outcomes. Current guidelines refer to the indication of transcatheter edge-to-edge repair (TEER) for significant SMR based on data from the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) trial if symptomatic despite optimal guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT), but nonpharmacological treatment for dynamic SMR remains challenging. In HFrEF patients with LV dyssynchrony and dynamic SMR, CRT can improve LV dyssynchrony and subsequently attenuate SMR at rest and during exercise. Also, a recent study suggests that TEER with GDMT and CRT is more effective in symptomatic patients with HFrEF and dynamic SMR than GDMT and CRT alone. Further studies are needed to evaluate the safety and efficacy of nonpharmacological treatments for dynamic SMR. In this review, current evidence and challenges for the future of dynamic SMR are discussed.
Collapse
Affiliation(s)
- Hirokazu Onishi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
- *Correspondence: Masaki Izumo
| | - Toru Naganuma
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| |
Collapse
|
3
|
Jamil HA, Goldberg SL, Witte KK. Cardiac resynchronization therapy following Carillon ® annuloplasty device for symptomatic heart failure and functional mitral regurgitation: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 3:1-5. [PMID: 31911977 PMCID: PMC6939793 DOI: 10.1093/ehjcr/ytz224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/28/2019] [Accepted: 11/21/2019] [Indexed: 11/18/2022]
Abstract
Background Symptomatic patients with significant left ventricular systolic dysfunction (LVSD) require a tailored treatment approach. Both functional mitral regurgitation (FMR) and left bundle branch block (LBBB) can develop, contributing to clinical deterioration, and worse prognosis despite optimal medical therapy (OMT). Case summary We report the case of a symptomatic 60-year-old man on OMT with LVSD and significant FMR. His symptoms and FMR initially improved following transvenous mitral annuloplasty using the Carillon® Mitral Contour System® annuloplasty device. However, he subsequently developed LBBB with associated reduction in exercise capacity, for which he underwent cardiac resynchronization therapy, and ensuing symptom improvement and stabilization. Discussion Our case describes how targeted device interventions can be combined synergistically to optimize patient symptoms.
Collapse
Affiliation(s)
- Haqeel A Jamil
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Building, Clarendon Way, Leeds LS2 9JT, UK
| | - Steven L Goldberg
- Tyler Heart Institute of Community Hospital of the Monterey Peninsula, 23625 Holman Hwy, Monterey, CA 93940, USA.,Cardiac Dimensions Inc, 5540 Lake Washington Blvd NE, Kirkland, WA 98033, USA
| | - Klaus K Witte
- Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LIGHT Building, Clarendon Way, Leeds LS2 9JT, UK
| |
Collapse
|
4
|
Lowry JE, Fichtlscherer S, Witte KK. Therapeutic options for functional mitral regurgitation in chronic heart failure. Expert Rev Med Devices 2018; 15:357-365. [PMID: 29724138 DOI: 10.1080/17434440.2018.1473032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Mitral regurgitation is a common finding in patients with chronic heart failure and is associated with a progressive worsening of symptoms, reduced survival and increased cost of care. However, the use of mitral valve surgery for these patients remains controversial and has not been shown to improve survival. Consequently, research has been increasingly directed towards the nonsurgical management of this important co-morbidity of heart failure. AREAS COVERED The present review will describe the relevance of mitral regurgitation in people with chronic heart failure, the current options for percutaneous treatment and the evidence base for each of these. EXPERT COMMENTARY Although at present there are few solid data to guide heart teams in deciding what degree of mitral regurgitation to treat, in which patients, and with what, this situation is likely to change over the next two years with the release of the first large randomised trials of percutaneous interventions.
Collapse
Affiliation(s)
- Judith E Lowry
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Stephan Fichtlscherer
- b Department of Internal Medicine, Division of Cardiology , University Hospital Frankfurt , Frankfurt am Main , Germany
| | - Klaus K Witte
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| |
Collapse
|