The study population consisted of 264 patients with CIEDs who were admitted to the Kafkas University Hospital Cardiology Outpatient Clinic between January 2021 and January 2023. Patients with a history of AF (n = 39), with a single chamber ventricular (VVI) PM (n = 6) or ICD (n = 9), with moderate-to-severe valve disease (n = 8) and/or prosthesis heart valve (n = 5) and atrial lead dysfunction (n = 3) were excluded from the study. After exclusion, the research sample consisted of 194 patients with CIEDs.
The study population was divided into two groups: patients with AHREs (n:77), i.e., the AHRE (+) group and patients without AHRE (n:117), i.e., the AHRE (-) group. The mean age of the sample, of which 133 (58%) was male, was 68 (± 12) years. Patients with the AHRE (+) group was older than the AHRE (-) group. There was no significant difference between the groups in comorbidities. The distribution of the baseline demographic characteristics and laboratory findings by the groups is shown in Table 1.
Table 1
The baseline demographic characteristics and the laboratory of the study population (Abbreviations; DM: Diabetes Mellites, HT: hypertension, CAD: Coronary Artery Disease, BSA: Body Surface Area, WBC: White Blood Cell, Hgb: Hemoglobin, Na: Sodium, K: Potassium, CPR: C-reactive Protein, TSH: Thyroid Stimulating Hormone, PM: Pace-Maker, ICD: Implantable Cardioverter-Defibrillator, CRT: Cardiac Resynchronization Therapy)
Variables | AHRE | |
AHRE (-), n:117 | AHRE (+), n:77 | Total, n:194 | P value |
Age, years | 67 ± 13 | 71 ± 12 | 68 ± 13 | 0.019 |
Male, n (%) | 72 (61.5%) | 41 (53.2%) | 113 (58.2%) | 0.253 |
DM, n (%) | 32 (27.4%) | 29 (37.7%) | 61 (31.4%) | 0.131 |
HT, n (%) | 73 (62.4%) | 58 (75.3%) | 131 (67.5%) | 0.610 |
CAD, n (%) | 83 (70.9%) | 62 (80.5%) | 145 (74.7%) | 0.134 |
Smoking, n (%) | 19 (16.2%) | 17 (22.1%) | 36 (18.6%) | 0.307 |
BSA, m2 | 1.846 ± 0.148 | 1.807 ± 0.145 | 1.831 ± 0.149 | 0.101 |
WBC Count, 103/µL | 7.41 ± 2.4 | 7.64 ± 1.76 | 7.5 ± 2.17 | 0.228 |
Neutrophil, 103/µL | 4.9 ± 2 | 5 ± 1.46 | 4.9 ± 1.8 | 0.441 |
Hgb, g/dL | 13 ± 1.8 | 13.35 ± 1.59 | 13.15 ± 1.73 | 0.235 |
Platelet, 103/µL | 218 ± 57 | 233 ± 66 | 224 ± 61 | 0.229 |
Na, mmol/L | 140 ± 2.7 | 140 ± 2.9 | 139 ± 2.8 | 0.250 |
K, mmol/L | 4.43 ± 0.48 | 4.5 ± 0.43 | 4.4 ± 0.45 | 0.320 |
Creatinine, mg/dL | 0.77 ± 0.39 | 0.84 ± 0.34 | 0.8 ± 0.37 | 0.108 |
Glucose, mg/dL | 111 (96–125) | 112 (98–144) | 111 (97–129) | 0.306 |
CRP, mg/dL | 4.14 (0.52–8.67) | 2.02 (0.84–5.54) | 3.18 (0.6–6.94) | 0.098 |
TSH, mIU/L | 1.45 (0.99–2.14) | 1.23 (0.75–1.89) | 1.33 (0.91–2.07) | 0.095 |
Device Type, n (%) | PM | 56 (47.9%) | 37 (48.1%) | 93 (47.9%) | 0.606 |
ICD | 37 (31.6%) | 18 (23.4%) | 55 (28.4%) |
CRT | 24 (20.5%) | 22 (28.6%) | 46 (23.7%) |
The distribution of echocardiographic findings by the groups is shown in Table 2. Accordingly, in terms of left-sided parameters, the E/Emseptal (13,6 ± 7,4 vs 15,7 ± 7,1; p = 0,005), E/Emlateral (9,8 ± 6 vs 11,5 ± 5; p = 0,005) and LAVI (37,32 ± 11 mL/m2 vs 45,21 ± 12,1 mL/m2; p < 0,001) values were significantly higher in the AHRE (+) group than in the AHRE (-) group. There was no significant difference between the groups in LVEF. Additionally, in terms of right-sided parameters, the RVS' (10,4 ± 3,2 cm/s vs 12,3 ± 4,2 cm/s; p = 0,011), TAPSE (19 ± 6 mm vs 21 ± 5 mm; p = 0,028) and TAPSE/TRV (10,8 ± 7,8 vs 11,9 ± 5,3; p = 0,003) values were significantly lower whereas the E/A tricuspid inflow (1,14 ± 0,49 vs 0,99 ± 0,47; p = 0,021), E/Em tricuspid ratio (7,5 ± 4,1 vs 6,3 ± 3,5; p = 0,009) and RAVI (35,78 ± 11,58 mL/m2 vs 29,38 ± 11,51 mL/m2; p < 0,001) values were significantly higher in the AHRE (+) group than in the AHRE (-) group.
Table 2
Echocardiographic variables for patients with and without AHRE (Abbreviations; E: Peak Early Inflow Velocity; A: Peak Late Inflow Velocity; Em: Early Diastolic Tissue Doppler Velocity; LAVI: Left Atrial Volume Index; LVEDD: Left Ventricle End Diastolic Diameter; LVEF: Left Ventricle Ejection Fraction; RV E’, RV A’ and RV S’: Right Ventricle peak Early (E’), Late (A’) and systolic (S’) tissue doppler velocities; TAPSE: Tricuspid Annular Plane Systolic Excursion; TR vel: Tricuspid Regurgitation Velocity, RAVI: Right Atrial Volume Index; RVFAC: Right Ventricle fractional area change)
Variables | AHRE | |
AHRE (-), n:117 | AHRE (+), n:77 | Total, n:194 | p value |
E, mitral (cm/s) | 69.2 ± 25.3 | 74.8 ± 24.4 | 71.4 ± 25.1 | 0.077 |
A, mitral (cm/s) | 71.2 ± 25.3 | 79.2 ± 31.9 | 74.4 ± 28.3 | 0.102 |
E/A, mitral | 1.19 ± 0.89 | 1.19 ± 0.89 | 1.18 ± 0.87 | 0.941 |
Emseptal, mitral (cm/s) | 5.7 ± 1.9 | 5.2 ± 1.7 | 5.5 ± 1.8 | 0.087 |
Emlateral, mitral (cm/s) | 8.1 ± 3 | 7.3 ± 2.3 | 7.8 ± 2.7 | 0.128 |
E/Emseptal, mitral | 13.6 ± 7.4 | 15.7 ± 7.1 | 14.4 ± 7.3 | 0.005 |
E/Emlateral, mitral | 9.8 ± 6 | 11 ± 5 | 10.3 ± 5.7 | 0.005 |
LAVI, (mL/m2) | 37.32 ± 11 | 45.21 ± 12.1 | 40.45 ± 12.06 | < 0.001 |
LVEDD, (cm) | 50 ± 9 | 52 ± 8 | 51 ± 9 | 0.101 |
LVEF, (%) | 36 ± 6 | 35 ± 8 | 38,5 ± 7,3 | 0.119 |
E, tricuspid (cm/s) | 51.1 ± 16.3 | 55.3 ± 17.5 | 52.8 ± 16.9 | 0.088 |
A, tricuspid (cm/s) | 57.3 ± 21.9 | 52.9 ± 16.3 | 55.6 ± 19.9 | 0.118 |
E/A, tricuspid | 0.99 ± 0.47 | 1.14 ± 0.49 | 1.05 ± 0.48 | 0.021 |
RV E', (cm/s) | 9.7 ± 4 | 8.4 ± 3 | 9.2 ± 3.7 | 0.055 |
RV A', (cm/s) | 14.1 ± 4.2 | 13.6 ± 8.4 | 13.9 ± 6.2 | 0.102 |
RV S', (cm/s) | 12.3 ± 4.2 | 10.4 ± 3.2 | 11.5 ± 4 | 0.011 |
E/Em, tricuspid | 6.3 ± 3.5 | 7.5 ± 4.1 | 6.76 ± 3.79 | 0.009 |
TAPSE, mm | 21 ± 5 | 19 ± 6 | 21 ± 5 | 0.028 |
TR Vel, m/s | 2.05 ± 0.74 | 2.21 ± 0.78 | 2.11 ± 0.76 | 0.072 |
TAPSE/TRV, mmx(m/s)−1 | 11.9 ± 5.3 | 10.8 ± 7.8 | 11.47 ± 6.44 | 0.003 |
RAVI, mL/m2 | 29.38 ± 11.51 | 35.78 ± 11.58 | 32 ± 11.95 | < 0,001 |
RVFAC, (%) | 45 ± 11 | 43 ± 13 | 44 ± 12 | 0.083 |
The multivariate analysis revealed age, LAVI, E/Em tricuspid (HR: 1,106, 1,015 − 1,205%95 CI, p = 0,022) and RAVI (HR: 1,035, 1,003 − 1,069 95% CI; p = 0,033) as independent predictors of AHREs (Table 3). ROC curve analysis indicated that an E/Em tricuspid cut-off value of 6.28 predicted AHREs with a sensitivity of 53,2% and a specificity of 66,7% (AUC: 0,611, 95% CI: 0,538-0,680 p:0.009) and a RAVI cut-off value of 29,5 mL/m2 predicted AHREs with a sensitivity of 72,7% and a specificity of 65,9% (AUC = AUC: 0,707, 95% CI 0,637-0,770 p < 0.001) (Fig. 1).
Table 3
Univariate and multivariate analyses of risk factors for AHRE (Abbreviations; E: Peak Early Inflow Velocity, A: Peak Late Inflow Velocity; Em: Early Diastolic Tissue Doppler Velocity; LAVI: Left Atrial Volume Index; RV S’: Right Ventricle Peak Systolic Tissue Doppler Velocity, TAPSE: Tricuspid Annular Plane Systolic Excursion; TR vel: Tricuspid Regurgitation Velocity, RAVI: Right Atrial Volume Index) (HR: Hazard Ratio, CI: Confidence Interval)
| Univariate | Multivariate |
Variable | HR | 95% CI | p value | HR | %95 CI | p value |
Age, years | 1.027 | (1.002–1.052) | 0.031 | 1.027 | (1.001–1.055) | 0.044 |
E/Emseptal mitral, cm/s | 1.041 | (0.999–1.082) | 0.055 | - |
E/Emlateral mitral, cm/s | 1.041 | (0.987–1.095) | 0.140 | - |
LAVI, mL/m2 | 1.062 | (1.032–1.092) | < 0.001 | 1.049 | (1.019–1.079) | 0.001 |
E/A ratio, tricuspid | 1.932 | (1.048–3.563) | 0.035 | - |
RV S', cm/s | 0.866 | (0.787–0.953) | 0.003 | | - | |
E/Em ratio, tricuspid | 1.092 | (1.009–1.182) | 0.028 | 1.106 (1.015–1.205) 0.022 |
TAPSE, mm | 0.935 | (0.884–0.989) | 0.019 | - |
TAPSE/TRvel, mmx(m/s)−1 | 0.968 | (0.921–1.017) | 0.197 | - |
RAVI, mL/m2 | 1.057 | (1.025–1.091) | < 0.001 | 1.035 | (1.003–1.069) | 0.033 |