Wojciech Jacheć, Anna Polewczyk, Dorota Nowosielecka, Andrzej Tomaszewski, Wojciech Brzozowski, Dorota Szczęśniak-Stańczyk, Krzysztof Duda, Agnieszka Nowosielecka, Andrzej Kutarski
{"title":"经静脉拔除导联后三尖瓣功能的变化、诱发因素和预后作用","authors":"Wojciech Jacheć, Anna Polewczyk, Dorota Nowosielecka, Andrzej Tomaszewski, Wojciech Brzozowski, Dorota Szczęśniak-Stańczyk, Krzysztof Duda, Agnieszka Nowosielecka, Andrzej Kutarski","doi":"10.31083/j.rcm2506198","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Changes in tricuspid valve (TV) function following transvenous lead extraction (TLE) and their impact on long-term survival have not yet been investigated.</p><p><strong>Methods: </strong>From 3633 patients undergoing lead extraction between 2006 and 2021, TV function before and after TLE was evaluated in 2693 patients.</p><p><strong>Results: </strong>After TLE, the TV function remained unchanged in 82.36% of patients, worsened in 9.54%, and improved in 8.10%. Abandoned leads (odds ratio, OR = 1.712; <i>p =</i> 0.044), fibrotic adhesions between leads and TV apparatus (OR = 3.596; <i>p</i> <math><mo><</mo></math> 0.001), or right ventricular wall (OR = 2.478; <i>p</i> <math><mo><</mo></math> 0.001) were predisposed to TV worsening. Non-infectious indications for TLE (OR = 1.925; <i>p</i> <math><mo><</mo></math> 0.001), the severity of tricuspid valve regurgitation (TVR) before TLE (OR = 3.125; <i>p</i> <math><mo><</mo></math> 0.001), and lead encapsulation (OR = 2.159; <i>p</i> <math><mo><</mo></math> 0.001) were predictors of improvement in TV function. Although either worsening or improving TV function had no impact on long-term survival in all patients, decreased TVR severity in the subgroup of patients with initial regurgitation grades 3-4 was associated with a better prognosis (hazard ratio, HR = 0.622; <i>p =</i> 0.005).</p><p><strong>Conclusions: </strong>1. Changes in TV function after TLE were observed in 17.64% of patients. 2. Various factors can predispose to lead-related TV changes, although the common denominator in these events is an extensive buildup of scar tissue. 3. Worsening TV function had no impact on survival after TLE. In patients with severe TV dysfunction, reduction in TVR following TLE was associated with a 40% reduction in mortality during a mean follow-up of 1673 days.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11270083/pdf/","citationCount":"0","resultStr":"{\"title\":\"Change in Tricuspid Valve Function after Transvenous Lead Extraction, Predisposing Factors and Prognostic Roles.\",\"authors\":\"Wojciech Jacheć, Anna Polewczyk, Dorota Nowosielecka, Andrzej Tomaszewski, Wojciech Brzozowski, Dorota Szczęśniak-Stańczyk, Krzysztof Duda, Agnieszka Nowosielecka, Andrzej Kutarski\",\"doi\":\"10.31083/j.rcm2506198\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Changes in tricuspid valve (TV) function following transvenous lead extraction (TLE) and their impact on long-term survival have not yet been investigated.</p><p><strong>Methods: </strong>From 3633 patients undergoing lead extraction between 2006 and 2021, TV function before and after TLE was evaluated in 2693 patients.</p><p><strong>Results: </strong>After TLE, the TV function remained unchanged in 82.36% of patients, worsened in 9.54%, and improved in 8.10%. Abandoned leads (odds ratio, OR = 1.712; <i>p =</i> 0.044), fibrotic adhesions between leads and TV apparatus (OR = 3.596; <i>p</i> <math><mo><</mo></math> 0.001), or right ventricular wall (OR = 2.478; <i>p</i> <math><mo><</mo></math> 0.001) were predisposed to TV worsening. Non-infectious indications for TLE (OR = 1.925; <i>p</i> <math><mo><</mo></math> 0.001), the severity of tricuspid valve regurgitation (TVR) before TLE (OR = 3.125; <i>p</i> <math><mo><</mo></math> 0.001), and lead encapsulation (OR = 2.159; <i>p</i> <math><mo><</mo></math> 0.001) were predictors of improvement in TV function. Although either worsening or improving TV function had no impact on long-term survival in all patients, decreased TVR severity in the subgroup of patients with initial regurgitation grades 3-4 was associated with a better prognosis (hazard ratio, HR = 0.622; <i>p =</i> 0.005).</p><p><strong>Conclusions: </strong>1. Changes in TV function after TLE were observed in 17.64% of patients. 2. 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引用次数: 0
摘要
背景:经静脉导联取出术(TLE)后三尖瓣(TV)功能的变化及其对长期生存的影响尚未得到研究:方法:从2006年至2021年期间接受导联取出术的3633名患者中,对2693名患者经静脉导联取出术前后的TV功能进行了评估:结果:TLE后,82.36%的患者TV功能保持不变,9.54%的患者恶化,8.10%的患者改善。废弃导联(几率比,OR = 1.712;P = 0.044)、导联与 TV 装置之间的纤维粘连(OR = 3.596;P 0.001)或右心室壁(OR = 2.478;P 0.001)易导致 TV 功能恶化。TLE的非感染性适应症(OR = 1.925;P 0.001)、TLE前三尖瓣反流(TVR)的严重程度(OR = 3.125;P 0.001)和导联封装(OR = 2.159;P 0.001)是预测TV功能改善的因素。虽然TV功能的恶化或改善对所有患者的长期生存没有影响,但在最初反流等级为3-4级的亚组患者中,TVR严重程度的降低与较好的预后相关(危险比,HR = 0.622; p = 0.005):1.1. 17.64%的患者在TLE后观察到TV功能的变化。2.2.各种因素都可能导致与导联相关的TV改变,但这些事件的共同点是瘢痕组织的广泛积聚。3.3. TV功能的恶化对TLE后的存活率没有影响。对于 TV 功能严重障碍的患者,TLE 后 TVR 的降低与平均 1673 天的随访期间死亡率降低 40% 有关。
Change in Tricuspid Valve Function after Transvenous Lead Extraction, Predisposing Factors and Prognostic Roles.
Background: Changes in tricuspid valve (TV) function following transvenous lead extraction (TLE) and their impact on long-term survival have not yet been investigated.
Methods: From 3633 patients undergoing lead extraction between 2006 and 2021, TV function before and after TLE was evaluated in 2693 patients.
Results: After TLE, the TV function remained unchanged in 82.36% of patients, worsened in 9.54%, and improved in 8.10%. Abandoned leads (odds ratio, OR = 1.712; p = 0.044), fibrotic adhesions between leads and TV apparatus (OR = 3.596; p 0.001), or right ventricular wall (OR = 2.478; p 0.001) were predisposed to TV worsening. Non-infectious indications for TLE (OR = 1.925; p 0.001), the severity of tricuspid valve regurgitation (TVR) before TLE (OR = 3.125; p 0.001), and lead encapsulation (OR = 2.159; p 0.001) were predictors of improvement in TV function. Although either worsening or improving TV function had no impact on long-term survival in all patients, decreased TVR severity in the subgroup of patients with initial regurgitation grades 3-4 was associated with a better prognosis (hazard ratio, HR = 0.622; p = 0.005).
Conclusions: 1. Changes in TV function after TLE were observed in 17.64% of patients. 2. Various factors can predispose to lead-related TV changes, although the common denominator in these events is an extensive buildup of scar tissue. 3. Worsening TV function had no impact on survival after TLE. In patients with severe TV dysfunction, reduction in TVR following TLE was associated with a 40% reduction in mortality during a mean follow-up of 1673 days.
期刊介绍:
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.