Three-dimensional echocardiography with left ventricular strain analyses helps earlier prediction of right ventricular pacing-induced cardiomyopathy

Babu, N M Sharath; Srinath, Sirish Chandra; Lahiri, Anandaroop; Chase, David; John, Bobby; Roshan, John

doi:10.1016/j.jsha.2017.06.001

Cited by 11 publications

(12 citation statements)

References 21 publications

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“…Using a clinical endpoint or reporting the reduction in LVEF is often a late phenomenon. Once LVEF is decreased, despite intervention there is a failure of recovery of systolic function in up to 58% of patients [ 24 ]. This created the need for an imaging modality that is relatively inexpensive and that can pick up early PICMP.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain

et al. 2021

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Background Long-term RV pacing leads to ventricular dyssynchrony, in the form of LBBB-like morphology, with subsequent detrimental effects on LV structure and function. Three-dimensional echocardiography allowed early detection of volumetric changes associated with PICMP and provided more accurate assessment of mechanical dyssynchrony. Speckle tracking strain is able to identify LV dysfunction even before any reduction in LVEF. Our aim was to study pacing effects on LV function and hemodynamics using 3D echo and speckle tracking strain. Results This was a prospective study of 175 consecutive patients without structural heart disease (LVEF > 50%) presented for permanent pacing. Full-volume 3D echocardiography done before implantation, 1 week, and 6 months together with GLS. Patients were followed for 6 months to detect incidence of PIVD (defined as reduction in LVEF > 10% but still above 50%) and PICMP (defined as decrease in LVEF by 10% from baseline in absence of other known causes of cardiomyopathy resulting in EF< 50%). PIVD and PICMP predictors and risk factors were analyzed. Only 50 patients met study criteria. Twenty-five (50%) patients developed LV systolic dysfunction; of these, 19 (38%) developed PIVD and 6 (12%) developed PICMP. Pre-implantation GLS was significantly lower in the 6 patients who subsequently developed PICMP, compared to those who developed PIVD and the preserved EF group (mean GLS − 15.50 vs. − 21.0, − 20.0 respectively; p = 0.005, 0.033, respectively). At 1 week, GLS was significantly lower in the 25 patients who subsequently developed PIVD, compared to those who did not (GLS − 13.0 vs. − 18.0, respectively; p = 0.002). A reduction of baseline GLS by 15% or more at 1 week was associated with the development of PIVD and PICMP (p = < 0.001). A wider native QRS complex was associated with PIVD and PICMP (p = 0.008, 0.018, respectively). The other predictors were found non-significant. Conclusion PICMP may be more common than previously reported and it may occur shortly after implantation. Pre-implantation GLS is a sensitive parameter for PICMP. One-week GLS, pre-implantation QRS complex width are early predictors for PICMP and PIVD before any reduction in EF.

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Section: Discussionmentioning

confidence: 99%

“…A significant decrease in LV global longitudinal strain was noted in 23 (63.9%) patients by 6 months. In seven of these patients, there was a significant decrease in global longitudinal strain 24 h after implantation [ 24 ]. In a recent study conducted in 2017, 93 patients were followed for 60 ± 47 months.…”

Section: Discussionmentioning

confidence: 99%

Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain

et al. 2021

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“…In a 6-month study of 36 patients without structural heart disease and LVEF greater than 45%, presented for permanent pacing, significant drops in LVEF were noted in 12 patients. A significant decrease in LV global longitudinal strain was noted in 23 patients [ 28 ]. Our study had a number of limitations, the most important was the small sample size.…”

Section: Discussionmentioning

confidence: 99%

Effects of cardiac pacemakers on left ventricular volumes and function assessed by 3D echocardiography, Doppler method, and global longitudinal strain

et al. 2021

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Background Many previous studies reported the negative effects of right ventricular (RV) pacing on the left ventricular (LV) structure and ejection fraction. Studying pacing hemodynamics is essential to understand these detrimental effects. In this study, we tried to understand RV pacing effects on LV volumes and function using advanced tools like 3D echo and global longitudinal strain (GLS). This was a prospective study of 175 consecutive patients (LVEF>50%) presented permanent pacing. Of 175 patients, only 50 patients met study criteria, divided into two groups (single or dual pacing). LV volumes and function were assessed by full-volume 3D echocardiography and GLS before pacing, at 1-week and 6-month post-pacing. Cardiac output (COP) was calculated by pulsed wave Doppler method and 3D echo. Results Doppler method results were similar to 3D echo in calculating SV and COP. At 1-week post pacing, both groups showed a significant decrease in SV due to a drop in EDV while ESV did not change significantly. Despite the drop in SV, there was a significant increase in cardiac output (COP) due to achieving higher heart rates post-pacing. There was a significant drop in EF and GLS in both groups. At 6 months, SV continued to decrease with a corresponding decrease in COP and LVEF. This drop in SV was due to a significant increase in ESV while EDV did not show a significant change at a 6-month follow-up. Also, the drop EF and GLS became more significant. There were no significant differences between both groups regarding the changes in LV volumes (EDV, ESV, SV), LVEF or GLS throughout the study (pre-pacing, at 1-week and 6-months post pacing). However, dual-chamber pacing group provided higher heart rates and as a result higher COP than the single-chamber group. Conclusions RV pacing led to a significant drop in LV COP, ejection fraction (EF), and GLS over short- and long-term duration. Dual chamber pacing provided higher COP than a single chamber pacing. This was due to tracking the S. A node with pacing at higher heart rates not due to an increase in SV and preserving atrioventricular synchrony. Both Doppler method and 3D echo can be used to calculate SV and COP.

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“…In addition to changes in LVEF and clinical HF events, even broader definitions of PICM may be invoked which look at asymptomatic perturbations in myocardial function in the setting of high burden RV pacing. Several studies have looked at echocardiographic parameters of systolic and diastolic function, such as speckle‐tracking strain analysis and indices of isovolumic contraction and relaxation times (Tei index), and have identified significant abnormalities induced by RV pacing which can be detected well before overt changes in LVEF occur. High‐burden RV pacing has also been associated with significant rises in natriuretic peptide levels, which may also signal abnormalities in myocardial function before the onset of symptoms or drop in LVEF …”

Section: Defining Pacing‐induced Cardiomyopathymentioning

confidence: 99%

Pacing induced cardiomyopathy

Merchant

Mittal

2019

Cardiovasc electrophysiol

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Pacing induced cardiomyopathy (PICM) is most commonly defined as a drop in left ventricle ejection fraction (LVEF) in the setting of chronic, high burden right ventricle (RV) pacing. Recent data suggest, however, that some individuals may experience the onset of heart failure symptoms more acutely after pacemaker implantation.Definitions of PICM which emphasize drop in LVEF may underestimate the incidence of deleterious effects from RV pacing. Treatment of PICM has primarily focused on upgrade to cardiac resynchronization therapy (CRT) when LVEF has dropped.However, emerging data suggest that conduction system pacing (CSP) may offer an opportunity to prevent PICM in the first place.cardiac resynchronization therapy, cardiomyopathy, conduction system pacing, device upgrade, dyssynchrony, his bundle pacing, left bundle branch block, pacemaker

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Three-dimensional echocardiography with left ventricular strain analyses helps earlier prediction of right ventricular pacing-induced cardiomyopathy

Cited by 11 publications

References 21 publications

Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain

Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain

Effects of cardiac pacemakers on left ventricular volumes and function assessed by 3D echocardiography, Doppler method, and global longitudinal strain

Pacing induced cardiomyopathy

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