Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement
Background: Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the...
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IMR Press
2025-01-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/26/1/10.31083/RCM26173 |
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| author | Sung Soo Kim Hyung Wook Park Hyung Ki Jeong |
| author_facet | Sung Soo Kim Hyung Wook Park Hyung Ki Jeong |
| author_sort | Sung Soo Kim |
| collection | DOAJ |
| description | Background: Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the relationship between RV pacing, global longitudinal strain (GLS), and EF in patients with preserved EF. Methods: This prospective registry study included patients with preserved EF (≥50%) undergoing de novo permanent pacemaker (PPM) implantation for atrioventricular block at Chosun University Hospital, South Korea, from 2018 to 2022. Echocardiographic evaluations were performed pre-implant, post-implant, and at 12 months, with follow-up visits every 3–6 months. Composite outcomes included cardiac death, heart failure hospitalization, pacing-induced cardiomyopathy (PICM), and biventricular pacing (BVP) upgrade. Results: A total of 71 patients (28 males, mean age 73.1 years) were included. Following PPM implantation, significant declines in both EF and GLS were noted, especially in those with PICM. Over three years, 2 patients died, 6 were hospitalized, 7 developed PICM, and 3 underwent a BVP upgrade. Reduced post-implant GLS was an independent predictor of PICM (hazard ratios (HR) 1.715, 95% CI 1.174–2.504; p = 0.005). Receiver operating characteristic (ROC) analysis showed an area under curve (AUC) of 0.92 for GLS, with a GLS <–15.0 having 100% sensitivity and 80.9% specificity for predicting PICM. Conclusions: Post-implant GLS is a reliable predictor of PICM in patients with preserved EF. Regular GLS monitoring can guide timely interventions, including guideline-directed medical therapy or BVP upgrades, to prevent deterioration and improve outcomes. |
| format | Article |
| id | doaj-art-b1d046cbd0184904a9f4edfa45ce4847 |
| institution | Kabale University |
| issn | 1530-6550 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-b1d046cbd0184904a9f4edfa45ce48472025-01-25T10:41:20ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-01-012612617310.31083/RCM26173S1530-6550(24)01620-XPost-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker PlacementSung Soo Kim0Hyung Wook Park1Hyung Ki Jeong2Department of Cardiovascular Medicine, Chosun University Medical School, 61469 Gwangju, Republic of KoreaDepartment of Cardiovascular Medicine, Chonnam National University Medical School, 61469 Gwangju, Republic of KoreaDepartment of Cardiovascular Medicine, Wonkwang University Medical School, 54536 Iksan, Republic of KoreaBackground: Right ventricular (RV) pacing exacerbates heart failure and increases cardiac mortality in patients with reduced ejection fraction (EF). However, its impact on left ventricular dysfunction in patients with preserved EF remains inconclusive. This study investigates the relationship between RV pacing, global longitudinal strain (GLS), and EF in patients with preserved EF. Methods: This prospective registry study included patients with preserved EF (≥50%) undergoing de novo permanent pacemaker (PPM) implantation for atrioventricular block at Chosun University Hospital, South Korea, from 2018 to 2022. Echocardiographic evaluations were performed pre-implant, post-implant, and at 12 months, with follow-up visits every 3–6 months. Composite outcomes included cardiac death, heart failure hospitalization, pacing-induced cardiomyopathy (PICM), and biventricular pacing (BVP) upgrade. Results: A total of 71 patients (28 males, mean age 73.1 years) were included. Following PPM implantation, significant declines in both EF and GLS were noted, especially in those with PICM. Over three years, 2 patients died, 6 were hospitalized, 7 developed PICM, and 3 underwent a BVP upgrade. Reduced post-implant GLS was an independent predictor of PICM (hazard ratios (HR) 1.715, 95% CI 1.174–2.504; p = 0.005). Receiver operating characteristic (ROC) analysis showed an area under curve (AUC) of 0.92 for GLS, with a GLS <–15.0 having 100% sensitivity and 80.9% specificity for predicting PICM. Conclusions: Post-implant GLS is a reliable predictor of PICM in patients with preserved EF. Regular GLS monitoring can guide timely interventions, including guideline-directed medical therapy or BVP upgrades, to prevent deterioration and improve outcomes.https://www.imrpress.com/journal/RCM/26/1/10.31083/RCM26173echocardiographyheart failurepacemakerartificial |
| spellingShingle | Sung Soo Kim Hyung Wook Park Hyung Ki Jeong Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement Reviews in Cardiovascular Medicine echocardiography heart failure pacemaker artificial |
| title | Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement |
| title_full | Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement |
| title_fullStr | Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement |
| title_full_unstemmed | Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement |
| title_short | Post-Implant Global Longitudinal Strain as a Predictor of Pacing-Induced Cardiomyopathy in Patients with Preserved Ejection Fraction Undergoing Pacemaker Placement |
| title_sort | post implant global longitudinal strain as a predictor of pacing induced cardiomyopathy in patients with preserved ejection fraction undergoing pacemaker placement |
| topic | echocardiography heart failure pacemaker artificial |
| url | https://www.imrpress.com/journal/RCM/26/1/10.31083/RCM26173 |
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