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Early pacing-induced systolic dyssynchrony is a strong predictor of left ventricular adverse remodeling: Analysis from the Pacing to Avoid Cardiac Enlargement (PACE) trial.
MedLine Citation:
PMID:  22944596     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Right ventricular apical (RVA) pacing is associated with adverse left ventricular (LV) remodeling and biventricular (BiV) pacing may prevent it although the mechanisms remain unclear. The current study aimed to assess the role of early pacing-induced systolic dyssynchrony (DYS) to predict adverse LV remodeling. METHODS: Patients with standard pacing indications and normal LV ejection fraction were randomized either to BiV (n=89) or RVA pacing (n=88). Pacing-induced DYS, defined as the standard deviation of the time to peak systolic velocity (Dyssynchrony Index) >33ms in a 12-segmental model of LV, was measured by tissue Doppler echocardiography at 1month. RESULTS: At 1month, 59 patients (33%) had DYS which was more prevalent in RVA than BiV pacing group (52% vs. 15%, χ(2)=28.3, p<0.001), though Dyssynchrony Index was similar at baseline (30±14 vs. 26±11ms, p=0.06). At 12months, those developing DYS had significantly lower LV ejection fraction (55.1±9.7 vs. 62.2±7.9%, p<0.001) and larger LV end-systolic volume (35.3±14.3 vs. 27.0±10.4ml, p<0.001) when compared to those without DYS. Reduction of ejection fraction ≥5% occurred in 67% (39 out of 58) of patients with DYS, but only in 18% (21 out of 115) in those without DYS (χ(2)=40.8, p<0.001). Both DYS at 1month (odds ratio [OR]: 4.725, p=0.001) and RVA pacing (OR: 3.427, p=0.009) were independent predictors for reduction of ejection fraction at 12months. CONCLUSION: Early pacing-induced DYS is a significant predictor of LV adverse remodeling and the observed benefit of BiV pacing may be related to the prevention of DYS. CLINICAL TRIAL REGISTRATION: Centre for Clinical Trials number, CUHK_CCT00037 (URL: http://www.cct.cuhk.edu.hk/Registry/publictrialrecord.aspx?trialid=CUHK_CCT00037).
Authors:
Fang Fang; Qing Zhang; Joseph Yat-Sun Chan; Omar Razali; Hussin Azlan; Hamish Chi-Kin Chan; John E Sanderson; Jun-Min Xie; Cheuk-Man Yu
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-31
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-9-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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