Evaluation of risk factors for tricuspid regurgitation prior to cardiac pacemaker

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.