Saito, M and Kaye, G and Negishi, K and Linker, N and Gammage, M and Kosmala, W and Marwick, TH, on behalf of the Protect-Pace investigators, Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing, Heart, 101, (8) pp. 600-608. ISSN 1355-6037 (2015) [Refereed Article]
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Background: Recent work has shown no difference in change of LVEF between RV apical (RVA) pacing and non-RVA pacing in patients with normal LV function. We hypothesised that a more sensitive marker (global longitudinal strain, GLS) could identify a detrimental effect of RVA and that assessment of deformation could identify whether dyssynchrony, contraction inefficiency and regional LV impairment were responsible for functional changes.
Methods: In this substudy of Protect-PACE (The Protection of Left Ventricular Function During Right Ventricular Pacing. Does Right Ventricular High-septal Pacing Improve Outcome Compared With Right Ventricular Apical Pacing?), a randomised controlled trial of RVA and non-RVA pacing in pacemaker-dependent patients with preserved EF, 145 patients (76 with RVA) with echocardiograms of sufficient quality underwent measurement of LV longitudinal strain (GLS) from speckle tracking just after implantation and at 2 years. LV dyssynchrony, discoordination and regional apical longitudinal strain were also measured.
Results: Pacing was associated with reduced GLS after 2 years, although 2-year GLS was lower in RVA (-13.9 ± 4.1 vs -15.5 ± 4.6, p = 0.02). RVA was an independent correlate of ΔGLS, although there was a minor difference in ΔGLS between the RVA and non-RVA groups (-1.8 ± 3.6 vs -0.8 ± 3.4%, p = 0.07), reflecting impairment of GLS at baseline in RVA. Apical strain was significantly lower in RVA than those in non-RVA at baseline and 2 years (both p < 0.01). Dyssynchrony and discoordination parameters at 2 years also showed significant deterioration in RVA. Apical strain, dyssynchrony and discoordination parameters at 2 years were significantly associated with ΔGLS.
Conclusions: Inefficient dyssynchronous contraction and the decrease in apical strain appear to be associated with global LV impairment in RVA.
|Item Type:||Refereed Article|
|Research Division:||Medical and Health Sciences|
|Research Group:||Cardiorespiratory Medicine and Haematology|
|Research Field:||Cardiology (incl. Cardiovascular Diseases)|
|Objective Group:||Clinical Health (Organs, Diseases and Abnormal Conditions)|
|Objective Field:||Cardiovascular System and Diseases|
|Author:||Saito, M (Dr Makoto Saito)|
|Author:||Negishi, K (Dr Kazuaki Negishi)|
|Author:||Kosmala, W (Professor Wojciech Kosmala)|
|Author:||Marwick, TH (Professor Tom Marwick)|
|Web of Science® Times Cited:||7|
|Deposited By:||Menzies Institute for Medical Research|
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