Dawood Moustafa, Elsharkawy Eman, Abdel-Hay Mohamed Ayman, Nawar Moustafa
Cardiology and Angiology Department, Alexandria Faculty of Medicine, Alexandria, 21568, Egypt.
Egypt Heart J. 2021 Jan 26;73(1):10. doi: 10.1186/s43044-021-00136-x.
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.
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.
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.
长期右心室起搏会导致心室不同步，表现为类似左束支传导阻滞的形态，进而对左心室结构和功能产生有害影响。三维超声心动图能够早期检测与起搏诱导性心肌病（PICMP）相关的容积变化，并能更准确地评估机械不同步。斑点追踪应变甚至在左心室射血分数（LVEF）降低之前就能识别左心室功能障碍。我们的目的是使用三维超声心动图和斑点追踪应变研究起搏对左心室功能和血流动力学的影响。
这是一项对175例连续的无结构性心脏病（LVEF>50%）且需进行永久起搏的患者的前瞻性研究。在植入前、1周和6个月时进行全容积三维超声心动图检查并测量整体纵向应变（GLS）。对患者进行6个月的随访，以检测起搏诱导性心室功能障碍（PIVD，定义为LVEF降低>10%但仍高于50%）和PICMP（定义为在无其他已知心肌病病因导致LVEF<50%的情况下，LVEF较基线降低10%）的发生率。分析PIVD和PICMP的预测因素和危险因素。只有50例患者符合研究标准。25例（50%）患者出现左心室收缩功能障碍；其中，19例（38%）发生PIVD，6例（12%）发生PICMP。与发生PIVD的患者和LVEF保留组相比，随后发生PICMP的6例患者植入前的GLS显著更低（平均GLS分别为-15.50、-21.0、-20.0；p分别为0.005和0.033）。在1周时，随后发生PIVD的25例患者的GLS显著低于未发生PIVD的患者（GLS分别为-13.0和-18.0；p = 0.002）。1周时基线GLS降低15%或更多与PIVD和PICMP的发生相关（p = <0.001）。较宽的自身QRS波群与PIVD和PICMP相关（p分别为0.008和0.018）。其他预测因素无显著意义。
PICMP可能比之前报道的更常见，且可能在植入后不久发生。植入前的GLS是PICMP的一个敏感参数。1周时的GLS、植入前QRS波群宽度是在EF降低之前PICMP和PIVD的早期预测指标。
