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Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing
Citation
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]
Copyright Statement
Copyright 2015 Copyright Article author (or their employer)
DOI: doi:10.1136/heartjnl-2014-306990
Abstract
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 Details
Item Type: | Refereed Article |
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Research Division: | Biomedical and Clinical Sciences |
Research Group: | Cardiovascular medicine and haematology |
Research Field: | Cardiology (incl. cardiovascular diseases) |
Objective Division: | Health |
Objective Group: | Clinical health |
Objective Field: | Clinical health not elsewhere classified |
UTAS Author: | Saito, M (Dr Makoto Saito) |
UTAS Author: | Negishi, K (Dr Kazuaki Negishi) |
UTAS Author: | Kosmala, W (Professor Wojciech Kosmala) |
UTAS Author: | Marwick, TH (Professor Tom Marwick) |
ID Code: | 98851 |
Year Published: | 2015 |
Web of Science® Times Cited: | 18 |
Deposited By: | Menzies Institute for Medical Research |
Deposited On: | 2015-03-04 |
Last Modified: | 2017-11-01 |
Downloads: | 0 |
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