1Charité - Universitätsmedizin Berlin CC11: Med. Klinik m.S. Kardiologie Berlin, Deutschland; 2Charité - Universitätsmedizin Berlin Medizinische Klinik m. S. Kardiologie, Kompetenznetz Herzinsuffizienz Berlin, Deutschland; 3Kardiologische Praxis Spreebogen Berlin, Deutschland
Background: Right ventricular pacing (RVP) is a common and effective treatment of cardiac electrical conduction disorders, but harmful effects are reported nowadays. Predictive clinical and imaging-derived measures to identify patients at high risk for pacemaker induced cardiomyopathy (PMIC)are lacking, but essential.
Objective: To assess innovative echocardiographic parameters in high versus low VP burden patients and the association with morbidity and mortality.
Methods: In 105 patients(59 male/46 female),who underwent a dual chamber pacemaker implantation at Charité Campus Virchow Klinikum from April 2011 to July 2016, right ventricular pacing burden (VPburden), left ventricular ejection fraction(LVEF) and left ventricular global longitudinal strain (LV-strain) were obtained.Mean follow-up per patient was 29.6±13.9 months. We used a stepwise analytic approach including ROC analysis, univariate testing, binary regression as well as Cox models and Kaplan-Meier analysis to compare low and high VP burden cohorts according to clinical outcome.
Results: Mean age of the patients was 74.2±9.7 years and 56% were male. Mean LVEF was 61±6%and GLS was 18±4%at baseline. We identified 7 patients with a decline in LVEF. High VP burden patients were more likely to develop LVEF and LV-strain decline (6 patients versus 1 patient for LVEF, p< 0.03; 28 patients versus 16 for LV-strain, respectively,p<0.001). LV-strain (OR:1.410,95% CI:1.201-1.610,p<0.001) and high VP burden (OR:1.358,95%CI:1.160-1.534, p<0.01) were associated with LVEF and LV-strain decline. Number of patients was higher and time to LVEF decline shorter in the high VP burden patients (p=0.004 and p<0.001, respectively).LV-strain decline within one year was a predictor of later LVEF decline and time to LVEF deterioration was shorter in patients with LV with LV-strain deterioration compared to patients without (34.7±4.2 months versus 53.7±1.4 months, respectively).
Conclusion: LV-strain is a sensitive long-term parameter of LVEF deterioration in patients at increased risk to develop PMIC and associated with a poor clinical outcome. It's effect needs to be proven in larger trials in the future. An early upgrade to biventricular pacing devices would be helpful to prevent HF onset in these patients and it appears necessary to reconsider the cut-off value of basic LVEF for CRT upgrade.
Keywords: Right ventricular pacing, left ventricular ejection fraction, global longitudinal strain, heart failure, prognosis
(p<0.001).straindeteriorationcomparedtopatientswithout(34.7±4.2monthsversus 53.7±1.4months,respectively)(p<0.001).