Author: CSANZ Admin

Prevalence and prognostic impact of tricuspid regurgitation in patients with cardiac implantable electronic devices: From the national echocardiography database of Australia

The prevalence and prognostic impact of tricuspid regurgitation (TR) in patients with a cardiac implantable electronic devices (CIEDs) is not well understood. This month in IJC [1] we published the results of the largest retrospective study on the subject to-date using the National Echo Database of Australia (NEDA). We found that moderate or greater TR is prevalent (23.8%) and 2-fold greater than in those without devices. Furthermore, moderate and severe CIED-associated TR was associated with a 1.6 to 2.5-fold increase in all-cause mortality. The association of CIED-related TR with a poor prognosis was also especially pertinent in younger individuals. With an ageing population and expanding indications for life-saving device-therapy, these findings highlight the need for close follow-up of patients with device therapies and for clinicians to be cognisant of the potential adverse consequences of CIED-associated TR.

Sophie Offen, Geoff Strange, David Playford, David Celermajer and Simon Stewart.

[1.] Offen S, Strange G, Playford D, Celermajer DS, Stewart S. Prevalence and prognostic impact of tricuspid regurgitation in patients with cardiac implantable electronic devices: From the national echocardiography database of Australia. International Journal of Cardiology 2022. https://www.sciencedirect.com/science/article/abs/pii/S0167527322016710

Longitudinal Assessment of Structural Phenotype in Brugada Syndrome Using Cardiac Magnetic Resonance Imaging

Recently published in Heart Rhythm O2 October 17, 2022  

With summary by author, Dr Julia C. Isbister 

Brugada syndrome (BrS) has traditionally been considered a channelopathy but in recent years, paralleling advancement in imaging techniques, subtle structural changes have been observed in a number BrS cohorts around the world. Cardiac magnetic resonance (CMR)imaging has revealed that patients with BrS have increased right ventricular and right ventricular outflow tract volumes compared to health controls. Focal fibrosis evidence by late gadolinium enhancement (LGE) has also been reported. Indeed, it has been postulated that BrS may be a focal cardiomyopathy rather than a pure ion channel disease.

This pilot study (n=18) represents the first time patients with BrS have been studied longitudinally with CMR and revealed that the myocardial changes can develop or progress over time. Most strikingly 22% of patients developed mid-wall LGE, typically associated with dilated cardiomyopathy, in the absence of other identifiable causes.

This work is hypothesis generating and we hope that the interesting results will prompt other groups around the world to review their patients with BrS to determine if progressive structural changes are observed in other cohorts. Ultimately, correlation of any progression of structural change with arrhythmic events and patient outcomes will be needed to determine the clinical implications of these observations and determine if serial structural assessment may aid risk stratification in BrS.

Isbister, J.C. et al, 2022, ‘Longitudinal Assessment of Structural Phenotype in Brugada Syndrome Using Cardiac Magnetic Resonance Imaging’ Heart Rhythm O2  

DOI: https://doi.org/10.1016/j.hroo.2022.10.004 

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