Right Ventricular Mechanics and Dyssynchrony as Determinants of Tricuspid Regurgitation Progression After Permanent...

Tricuspid regurgitation (TR) progression is a recognized complication following permanent pacemaker (PPM) implantation with a significant impact on morbidity and mortality. The role of procedural aspects as well as advanced echocardiographic parameters in predicting TR progression remains incompletely defined.

To investigate procedural factors and echocardiographic parameters predicting progression to moderate-to-severe TR following PPM implantation.

Fifty-two consecutive patients undergoing PPM implantation were prospectively included. Conventional echocardiography and speckle-tracking echocardiography (STE) were performed at baseline, 3 months, and 6 months post-implantation. Patients were classified according to the development of moderate-to-severe TR during follow-up.

Moderate-to-severe TR developed in 17 patients (32.7%) during follow-up. Baseline clinical and echocardiographic parameters were largely comparable between groups, although patients with subsequent TR progression had mildly impaired baseline RV free wall longitudinal strain (RV-FWLS) (p = 0.04). At 3 months, patients with TR progression demonstrated worse RV-FWLS (p = 0.01), higher RV dyssynchrony index (p = 0.02), and larger tricuspid annular diameter (p = 0.04). On multivariable analysis, the direct trans-tricuspid crossing technique (OR 5.42, 95% CI 1.01-29.12; p = 0.048), ventricular pacing burden (OR 1.39, 95% CI 1.05-1.86; p = 0.02), 3-month RV-FWLS (OR 1.47, 95% CI 1.01-2.15; p = 0.04) and 3-month RV dyssynchrony index (OR 1.54, 95% CI 1.02-2.31; p = 0.03) could independently predicted TR progression. ROC analysis showed good predictive performance for RV dyssynchrony index (AUC 0.86) and RV-FWLS (AUC 0.83).

Early abnormalities in RV strain and mechanical dyssynchrony were associated with subsequent TR progression following PPM implantation, highlighting the potential value of advanced echocardiographic assessment for early risk stratification.