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Predictors of worsening TR severity after right ventricular lead placement: any added value by post-procedural fluoroscopy versus three –dimensional echocardiography?
Cardiovascular Ultrasound ( IF 1.9 ) Pub Date : 2021-11-21 , DOI: 10.1186/s12947-021-00267-w
Hoorak Poorzand 1 , Mohammad Tayyebi 2 , Sara Hosseini 3 , Alireza Heidari Bakavoli 4 , Faeze Keihanian 3 , Lida Jarahi 5 , Ali Hamadanchi 6
Affiliation  

The effect of right ventricular (RV) leads on tricuspid valve has been already raised concerns, especially in terms of prognostic implication. For such assessment, three-dimensional transthoracic echocardiography (3D-TTE) has been used previously but there was no data on the use of post-procedural fluoroscopy in the literature. We prospectively enrolled 59 patients who underwent clinically indicated placement of pacemaker or implantable cardioverter defibrillator (ICD). Vena contracta (VC) and tricuspid regurgitation (TR) severity were measured using two-dimensional transthoracic echocardiography (2D-TTE) at baseline. Follow up 3D-TTE was performed 6 months after device implantation to assess TR severity and RV lead location. Lead placement position in TV was defined in 51 cases.TR VC was increased after the lead placement, compared to the baseline study (VC: 3.86 ± 2.32 vs 3.18 ± 2.39; p = 0.005), with one grade worsening in TR in 25.4% of cases. The mean changes in VC levels were 1.14 ± 0.67 mm. Among all investigated parameters, VC changes were predicted based on lead placement position only in 3D-TTE (p < 0.001) while the other variables including fluoroscopy parameters were not informative. The RV Lead location examined by 3D-TTE seems to be a valuable parameter to predict the changes in the severity of the tricuspid regurgitation. Fluoroscopy findings did not improve the predictive performance, at least in short term follow up.

中文翻译:

右心室导线放置后 TR 严重程度恶化的预测因素:术后透视与三维超声心动图相比有何附加价值?

右心室 (RV) 导联对三尖瓣的影响已经引起关注,尤其是在预后影响方面。对于此类评估,以前曾使用过三维经胸超声心动图 (3D-TTE),但文献中没有关于使用术后透视的数据。我们前瞻性地招募了 59 名接受了临床指征的心脏起搏器或植入式心律转复除颤器 (ICD) 放置的患者。在基线时使用二维经胸超声心动图 (2D-TTE) 测量收缩静脉 (VC) 和三尖瓣关闭不全 (TR) 的严重程度。装置植入后 6 个月进行 3D-TTE 随访,以评估 TR 严重程度和 RV 导线位置。51例在电视中定义了引线放置位置。引线放置后TR VC增加,与基线研究相比(VC:3.86 ± 2.32 vs 3.18 ± 2.39;p = 0.005),在 25.4% 的病例中,TR 恶化了一个等级。VC 水平的平均变化为 1.14 ± 0.67 毫米。在所有研究的参数中,仅根据 3D-TTE 中的引线放置位置预测 VC 变化(p < 0.001),而包括透视参数在内的其他变量没有提供信息。3D-TTE 检查的 RV 导联位置似乎是预测三尖瓣反流严重程度变化的一个有价值的参数。透视检查结果并没有提高预测性能,至少在短期随访中是这样。VC 变化仅根据 3D-TTE 中的引线放置位置进行预测(p < 0.001),而包括透视参数在内的其他变量没有提供信息。3D-TTE 检查的 RV 导联位置似乎是预测三尖瓣反流严重程度变化的一个有价值的参数。透视检查结果并没有提高预测性能,至少在短期随访中是这样。VC 变化仅根据 3D-TTE 中的引线放置位置进行预测(p < 0.001),而包括透视参数在内的其他变量没有提供信息。3D-TTE 检查的 RV 导联位置似乎是预测三尖瓣反流严重程度变化的一个有价值的参数。透视检查结果并没有提高预测性能,至少在短期随访中是这样。
更新日期:2021-11-22
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