Background: The development or progression of tricuspid regurgitation (TR) following the implantation of cardiovascular implantable electronic devices (CIED) represents a significant concern. Although the link between transvalvular lead placement and TR is well established, further research is required to elucidate the underlying factors that predispose patients to develop patient-related and lead-induced TR. The impact of the number of leads passing through the tricuspid valve and the lead diameter on the severity of tricuspid regurgitation remains unclear. This study investigated the effect of adding a pacing/ sensing lead (PSL) or an add-on ICD lead implantation on tricuspid valve function. Methods: In this retrospective, single-center, case-control study, all ICD implantation patients, in cases performed by one of these authors, presenting with lead failure were screened. Echocardiographic reports of patients who underwent additional PSL or ICD lead implantation were reviewed. Results: A total of 52 patients were included in the study. An additional pacing/sensing lead was implanted in 28 patients and an add-on ICD lead was implanted in 24 patients. The mean echocardiographic follow-up time (months) after intervention was similar in both groups (19.7 ± 17.7 vs. 18.2 ± 16.5 p:0.94). There was no significant difference between groups regarding age, gender, etiology of heart disease, and types of ICD. The addition of PSL did not result in a statistically significant increase in the degree of tricuspid regurgitation. (p:0,705). We did not find a significant increase in the degree of tricuspid regurgitation in patients in whom ICD leads were added (p: 0.059). There was no significant difference between the two groups in terms of the change in TR grade (p: 0.130). Conclusion: Although the relationship between CIED-mediated TV dysfunction and tricuspid valve dysfunction is clear, the effect of lead-related factors, such as the increased number and diameter of leads, on tricuspid valve dysfunction is unknown. This is the first study to investigate the effect of new shock lead insertion versus new PSL insertion strategies on lead-related tricuspid regurgitation in patients with lead failure. The findings indicate that adding a PSL or ICD lead in patients requiring lead addition due to lead failure did not increase tricuspid valve dysfunction.

Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF