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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Evaluation of risk factors for tricuspid regurgitation prior to cardiac pacemaker

  • Shuangling Wang1,2
  • Qiuzhe Guo1
  • Li Li1
  • Guochun Li1
  • Ying Zhou1
  • Yunfei Zhou1
  • Guodong Niu1
  • Yulong Guo1
  1. 1Fuwai Yunnan Hospital, Chinese Academy of Medical Sciences, Affiliated Cardiovascular Hospital of Kunming Medical University
  2. 2Department of Cardiology, Jiangchuan District People’s Hospital
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Abstract

Objective: To identify factors associated with preprocedural tricuspid regurgitation (TR) in patients with bradyarrhythmia undergoing cardiac pacemaker implantation and to evaluate the impact of preprocedural TR severity on postprocedural TR evolution and clinical outcomes.

Methods: This retrospective study included 767 patients with bradyarrhythmia who underwent permanent pacemaker implantation at Fuwai Yunnan Cardiovascular Hospital between January 2020 and October 2024. Patients were stratified into four groups according to preprocedural TR severity: none, mild, moderate, and severe. Clinical data, laboratory parameters, and echocardiographic parameters were collected. Univariate analysis was used to compare differences among groups, and ordinal logistic regression was used to identify independent factors associated with preprocedural TR. Among the 501 patients with follow-up of at least 2 months, binary logistic regression was used to evaluate the impact of preprocedural TR on postprocedural outcomes.

Results: Multivariable analysis showed that female sex (OR = 1.573), heart failure (OR = 1.837), persistent atrial fibrillation (OR = 4.958), and pulmonary hypertension (OR = 6.586) were independent risk factors for greater preprocedural TR severity, whereas higher BMI (OR = 0.920) was an independent protective factor (all P < 0.05). At a median follow-up of 16 months after pacemaker implantation, greater preprocedural TR severity was associated with more frequent postprocedural rehospitalizations ( P = 0.007) and a higher risk of cardiac function deterioration ( P < 0.001). Compared with patients without preprocedural TR, those with moderate or severe preprocedural TR had a significantly lower risk of postprocedural TR worsening and a higher rate of TR improvement, with this benefit being more pronounced in younger patients.

Conclusions: In patients with bradyarrhythmia undergoing cardiac pacing, preprocedural TR severity is influenced by multiple factors, including sex, heart failure, atrial fibrillation, and pulmonary hypertension. Greater preprocedural TR severity is associated with worse postprocedural cardiac functional outcomes. Among patients with pre-existing moderate-to-severe TR, a substantial proportion show improvement in TR after pacemaker implantation, and younger patients are more likely to benefit from such improvement. Cardiac pacing does not exert exclusively detrimental effects on TR.

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Cite

BibTeXRIS
BibTeX
@article{wang2026evaluation,
  title = {{Evaluation of risk factors for tricuspid regurgitation prior to cardiac pacemaker}},
  author = {Shuangling Wang and Qiuzhe Guo and Li Li and Guochun Li and Ying Zhou and Yunfei Zhou and Guodong Niu and Yulong Guo},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1690362},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1690362/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Evaluation of risk factors for tricuspid regurgitation prior to cardiac pacemaker
AU  - Shuangling Wang
AU  - Qiuzhe Guo
AU  - Li Li
AU  - Guochun Li
AU  - Ying Zhou
AU  - Yunfei Zhou
AU  - Guodong Niu
AU  - Yulong Guo
PY  - 2026
DA  - 2026/11/03
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1690362
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1690362/full
AB  - Objective: To identify factors associated with preprocedural tricuspid regurgitation (TR) in patients with bradyarrhythmia undergoing cardiac pacemaker implantation and to evaluate the impact of preprocedural TR severity on postprocedural TR evolution and clinical outcomes.  Methods: This retrospective study included 767 patients with bradyarrhythmia who underwent permanent pacemaker implantation at Fuwai Yunnan Cardiovascular Hospital between January 2020 and October 2024. Patients were stratified into four groups according to preprocedural TR severity: none, mild, moderate, and severe. Clinical data, laboratory parameters, and echocardiographic parameters were collected. Univariate analysis was used to compare differences among groups, and ordinal logistic regression was used to identify independent factors associated with preprocedural TR. Among the 501 patients with follow-up of at least 2 months, binary logistic regression was used to evaluate the impact of preprocedural TR on postprocedural outcomes.  Results: Multivariable analysis showed that female sex (OR = 1.573), heart failure (OR = 1.837), persistent atrial fibrillation (OR = 4.958), and pulmonary hypertension (OR = 6.586) were independent risk factors for greater preprocedural TR severity, whereas higher BMI (OR = 0.920) was an independent protective factor (all P < 0.05). At a median follow-up of 16 months after pacemaker implantation, greater preprocedural TR severity was associated with more frequent postprocedural rehospitalizations ( P = 0.007) and a higher risk of cardiac function deterioration ( P < 0.001). Compared with patients without preprocedural TR, those with moderate or severe preprocedural TR had a significantly lower risk of postprocedural TR worsening and a higher rate of TR improvement, with this benefit being more pronounced in younger patients.  Conclusions: In patients with bradyarrhythmia undergoing cardiac pacing, preprocedural TR severity is influenced by multiple factors, including sex, heart failure, atrial fibrillation, and pulmonary hypertension. Greater preprocedural TR severity is associated with worse postprocedural cardiac functional outcomes. Among patients with pre-existing moderate-to-severe TR, a substantial proportion show improvement in TR after pacemaker implantation, and younger patients are more likely to benefit from such improvement. Cardiac pacing does not exert exclusively detrimental effects on TR.
SN  - 2297-055X
ER  -