Mechanism of Left Ventricular Dysfunction due to Permanent Pacemaker: An Analysis of miR-155, sTNFR-2, MMP-9, N-Cad, and ZO-1.

CONTEXT: Total atrio-ventricular block is a lethal condition and is an indication of permanent pacemaker (PPM) implantation. Although PPM is lifesaving, patients frequently develop left ventricular dysfunction (LVd) which is traditionally detected with left ventricular ejection fraction (LVEF). Global longitudinal strain (GLS) may detect LVd before a decrease in LVEF. Cellular mechanisms of LVd following PPM implantation remain poorly understood.

AIMS: This study aimed to evaluate biomarker changes associated with the development of LVd following PPM implantation.

SETTINGS AND

DESIGN

This quasi-experimental study was conducted on adult patients undergoing PPM implantation.

SUBJECTS AND

METHODS

Echocardiography parameters and blood samples were obtained before PPM implantation (P0), at 1 month (P1) and at 3 months (P3). Patients divided into two groups (decreased GLS vs. unchanged GLS group) based on Delta P1 to P3 GLS. Biomarkers (miR-155, sTNFR-2, MMP-9, N-Cad, and ZO-1) concentration at P0 are compared to P1 and P3 between groups.

STATISTICAL ANALYSIS USED: Data were evaluated using nonparametric and parametric tests, repeated-measures analyses, and multivariate modeling as appropriate.

RESULTS

A total of 42 patients were included. There is a significant difference of P1 sTNFR-2 concentration between decreased GLS group and unchanged GLS group (1947.75 [standard deviation (SD) 103.80] vs. 1778.01 [SD 237.16]; P: 0.003). Moreover, general linier model showed a higher concentration of sTNFR-2 in patients with GLS decreased compared to unchanged GLS, although the difference is insignificant (P: 0.340). There was no statistically significant difference of other biomarkers in the study.

CONCLUSION

STNFR-2 may represent an early inflammatory signal associated with relative GLS deterioration following permanent pacemaker implantation.