Right Ventricular Mechanics and Dyssynchrony as Determinants of Tricuspid Regurgitation Progression After Permanent Pacemaker Implantation: A Speckle‐Tracking Echocardiography Study

Abstract

BACKGROUND: 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. OBJECTIVE: To investigate procedural factors and echocardiographic parameters predicting progression to moderate-to-severe TR following PPM implantation. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.