Echocardiography (Mount Kisco, N.Y.) · 2026
Right Ventricular Pacing Burden-Dependent Biventricular Remodeling in Patients With Preserved Left Ventricular Ejection Fraction: A Prospective Longitudinal Study.
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Malikides Onoufrios, Marketou Maria, Papazachariou Andria, Malikides Vironas, Chlouverakis Gregory, Kallergis Eleftherios, Patrianakos Alexandros, Simantirakis Emmanuel
Аннотация
PURPOSE: To assess right ventricular (RV) systolic trajectories across right ventricular pacing (RVP) burdens and their relationship with left ventricular (LV) remodeling in patients with preserved baseline LV ejection fraction (LVEF).
METHODS: This prospective study included 200 patients undergoing dual-chamber pacemaker implantation with an apical RV lead. Clinical, electrocardiographic, device, and echocardiographic assessments were performed at baseline, three months, and 12 months. Patients were grouped by RVP burden: 0%-3% (n = 43), 70%-79% (n = 51), or ≥80% (n = 106). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), and tricuspid annular plane systolic excursion (TAPSE) were evaluated using adjusted linear mixed-effects models. Continuous RVP associations and concurrent RV-LV changes were examined.
RESULTS: Among 200 patients (median age, 79 years), adjusted mixed-effects models demonstrated significantly different longitudinal trajectories across RVP groups for RVGLS (Holm-adjusted p = 0.0096) and TAPSE (Holm-adjusted p = 0.050), but not for RVFAC (Holm-adjusted p = 0.252). RVGLS and TAPSE deteriorated with high RVP while remaining comparatively stable with minimal pacing. Within the 70%-100% range, each 10% higher RVP burden was associated with an additional TAPSE reduction of 0.305 at 3-months (95%CI, 0.084, 0.527; p = 0.007) and 0.401 mm at 12-months (95%CI, 0.179, 0.622 mm; p < 0.001). The overall continuous time-by-RVP interaction was significant for TAPSE (Holm-adjusted p = 0.0035), but not for RVGLS or RVFAC. Worsening LVGLS was associated with deterioration in all RV indices at both assessments (FDR-adjusted p ≤ 0.0017), while increasing LV end-systolic volume was associated with all RV indices at 12-months (all FDR-adjusted p < 0.001).
CONCLUSION: Substantial RVP was associated with statistically detectable changes in RV indices. Within the high-pacing range, greater RVP burden was associated with a greater longitudinal decline in TAPSE. Concurrent RV-LV changes were also present, although their clinical significance requires further investigation.
METHODS: This prospective study included 200 patients undergoing dual-chamber pacemaker implantation with an apical RV lead. Clinical, electrocardiographic, device, and echocardiographic assessments were performed at baseline, three months, and 12 months. Patients were grouped by RVP burden: 0%-3% (n = 43), 70%-79% (n = 51), or ≥80% (n = 106). RV global longitudinal strain (RVGLS), RV fractional area change (RVFAC), and tricuspid annular plane systolic excursion (TAPSE) were evaluated using adjusted linear mixed-effects models. Continuous RVP associations and concurrent RV-LV changes were examined.
RESULTS: Among 200 patients (median age, 79 years), adjusted mixed-effects models demonstrated significantly different longitudinal trajectories across RVP groups for RVGLS (Holm-adjusted p = 0.0096) and TAPSE (Holm-adjusted p = 0.050), but not for RVFAC (Holm-adjusted p = 0.252). RVGLS and TAPSE deteriorated with high RVP while remaining comparatively stable with minimal pacing. Within the 70%-100% range, each 10% higher RVP burden was associated with an additional TAPSE reduction of 0.305 at 3-months (95%CI, 0.084, 0.527; p = 0.007) and 0.401 mm at 12-months (95%CI, 0.179, 0.622 mm; p < 0.001). The overall continuous time-by-RVP interaction was significant for TAPSE (Holm-adjusted p = 0.0035), but not for RVGLS or RVFAC. Worsening LVGLS was associated with deterioration in all RV indices at both assessments (FDR-adjusted p ≤ 0.0017), while increasing LV end-systolic volume was associated with all RV indices at 12-months (all FDR-adjusted p < 0.001).
CONCLUSION: Substantial RVP was associated with statistically detectable changes in RV indices. Within the high-pacing range, greater RVP burden was associated with a greater longitudinal decline in TAPSE. Concurrent RV-LV changes were also present, although their clinical significance requires further investigation.