Gierula John, Cubbon Richard M, Jamil Haqeel A, Byrom Rowenna J, Waldron Zac L, Pavitt Sue, Kearney Mark T, Witte Klaus K A
aLeeds Teaching Hospitals NHS Trust bDivision of Cardiovascular and Diabetes Research, Leeds Institute of Genetics, Health and Therapeutics, Multidisciplinary Cardiovascular Research Centre, University of Leeds cLeeds Institute of Health Sciences, Leeds, UK.
J Cardiovasc Med (Hagerstown). 2015 Nov;16(11):743-50. doi: 10.2459/JCM.0000000000000117.
Patients with right ventricular pacemakers are at increased risk of left ventricular systolic dysfunction (LVSD). We aimed to establish the prevalence, degree and associations of LVSD in patients with long-term right ventricular pacemakers listed for pulse generator replacement (PGR).
All patients listed for PGR at Leeds General Infirmary were invited to attend for an assessment during which we recorded medical history, symptomatic status, medical therapy, date and indication of first implantation, the percentage of right ventricular pacing (% RVP) and an echocardiogram.
We collected data on 491 patients. A left ventricular ejection fraction less than 50% was observed in 40% of our cohort, however, this was much higher (59%) in those with more than 80% RVP than in those with less than 80% RVP (22%) (P < 0.0001). Multivariable analysis revealed % RVP, (but not complete heart block at baseline), serum creatinine and previous myocardial infarction to be independently related to the presence of LVSD. A model combining % RVP and previous myocardial infarction has a c-statistic of 0.74 for predicting LVSD. After a mean follow-up time of 668 days, 56 patients (12%) were dead or had been hospitalized for heart failure. In multivariable analysis, previous myocardial infarction and high % RVP were independently associated with a worse survival.
Patients with right ventricular pacemakers have a high prevalence of LVSD, and this is greater in those exposed to more RVP. Those with LVSD and high amounts of RVP are at higher risk of hospitalization or death. Simple variables can identify those patients who might benefit from a more comprehensive review.
植入右心室起搏器的患者发生左心室收缩功能障碍（LVSD）的风险增加。我们旨在确定计划更换脉冲发生器（PGR）的长期右心室起搏器患者中LVSD的患病率、程度及相关因素。
邀请所有在利兹总医院计划进行PGR的患者前来进行评估，期间我们记录了病史、症状状态、药物治疗、首次植入的日期和指征、右心室起搏百分比（%RVP）以及超声心动图检查结果。
我们收集了491例患者的数据。在我们的队列中，40%的患者左心室射血分数低于50%，然而，%RVP超过80%的患者中这一比例更高（59%），高于%RVP低于80%的患者（22%）（P<0.0001）。多变量分析显示，%RVP（而非基线时的完全性心脏传导阻滞）、血清肌酐和既往心肌梗死与LVSD的存在独立相关。结合%RVP和既往心肌梗死的模型预测LVSD的c统计量为0.74。平均随访668天后，56例患者（12%）死亡或因心力衰竭住院。在多变量分析中，既往心肌梗死和高%RVP与较差的生存率独立相关。
植入右心室起搏器的患者LVSD患病率较高，且在接受更多右心室起搏的患者中更为明显。患有LVSD且右心室起搏量大的患者住院或死亡风险更高。简单的变量可以识别那些可能从更全面评估中获益的患者。
