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Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing


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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Copyright 2015 Copyright Article author (or their employer)

DOI: doi:10.1136/heartjnl-2014-306990


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 (-13.94.1 vs -15.54.6, 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 (-1.83.6 vs -0.83.4%, 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
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

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