Yoshioka Goro, Yamaguchi Takanori, Tanaka Atsushi, Sakai Hikari, Koyamatsu Junji, Umeki Toshiharu, Kaneta Kohei, Sakamoto Yoshiko, Kawaguchi Atsushi, Node Koichi
Department of Cardiovascular Medicine, Saga University, Saga, Japan.
Department of Clinical Laboratory Medicine, Faculty of Medicine, Saga University, Saga, Japan.
ESC Heart Fail. 2024 Dec;11(6):3982-3992. doi: 10.1002/ehf2.14973. Epub 2024 Jul 29.
This study aimed to investigate the clinical impact of pre-procedural left atrial strain (LAS) in patients undergoing permanent pacemaker implantation (PPI).
This single-centre retrospective study enrolled 434 patients who were admitted for transvenous PPI between 2010 and 2020. After excluding patients with persistent atrial fibrillation, PPI for complete atrioventricular block, severe valvular disease, history of open-heart surgery and those without LAS data, 172 patients were analysed. The LAS was measured using commercially available software to calculate the average strain value of the apical four- and two-chamber views before PPI. The primary composite endpoint was hospitalization due to heart failure or cardiovascular death. Cox proportional hazard models were used to evaluate risk factors for the primary composite endpoint. The mean patient age was 78 ± 8 years, and 42% of the patients were men. PPI was performed for sick sinus syndrome in 64% and second-degree atrioventricular block in 36% of the patients. The pre-procedure left atrial reservoir strain (LASr) was 28 ± 11%. The median follow-up period was 4.7 years, and the primary endpoint was observed in 23 (13%) patients. In multivariate Cox proportional risk analysis, LASr was independently associated with the primary composite endpoint (hazard ratio, 1.08 per 1% decrease; 95% confidence interval, 1.02-1.15; P = 0.007). The receiver operating characteristic curve of the LASr for the primary composite endpoint showed a cutoff value of 21% (area under the curve 0.657, P = 0.004). The prognostic impact of LASr was consistent with that of sick sinus syndrome and atrioventricular block.
A decreased pre-procedure LASr was associated with long-term adverse outcomes after PPI use.
本研究旨在探讨永久起搏器植入术（PPI）患者术前左心房应变（LAS）的临床影响。
这项单中心回顾性研究纳入了2010年至2020年间因经静脉PPI入院的434例患者。排除持续性心房颤动、完全性房室传导阻滞的PPI、严重瓣膜疾病、心脏直视手术史患者以及无LAS数据的患者后，对172例患者进行分析。使用商用软件测量LAS，以计算PPI前心尖四腔和两腔视图的平均应变值。主要复合终点是因心力衰竭或心血管死亡住院。采用Cox比例风险模型评估主要复合终点的危险因素。患者平均年龄为78±8岁，42%为男性。64%的患者因病态窦房结综合征接受PPI，36%的患者因二度房室传导阻滞接受PPI。术前左心房储存应变（LASr）为28±11%。中位随访期为4.7年，23例（13%）患者出现主要终点。在多变量Cox比例风险分析中，LASr与主要复合终点独立相关（风险比，每降低1%为1.08；95%置信区间，1.02 - 1.15；P = 0.007）。LASr对主要复合终点的受试者工作特征曲线显示临界值为21%（曲线下面积0.657，P = 0.004）。LASr的预后影响与病态窦房结综合征和房室传导阻滞一致。
术前LASr降低与PPI使用后的长期不良结局相关。
