Left ventricular myocardial longitudinal strain and dyssynchrony in patients with ventricular pacing in the long-term postoperative period

A. Harypau, I. Patsiayuk

Purpose. To study the parameters of longitudinal strain of the left ventricular myocardium and dyssynchrony in young patients with ventricular pacing in the long-term postoperative period. Materials and methods. The study included 60 patients aged 18 to 35 with pacemakers. The first group consisted of 30 patients (17 men and 13 women) with permanent pacemakers implanted after surgical correction of congenital heart defect (CHD) due to postoperative atrioventricular block (AV block). The second group included 30 patients (18 men and 12 women) with non-surgical AV block who required the implantation of a permanent pacemaker. All patients underwent echocardiography to determine the longitudinal strain
of the left ventricular (LV) myocardium and assess dyssynchrony. Results. Significant differences were found in the study groups regar - ding regional and total global longitudinal strain (GLS) of the LV myocardium. In group 1, the strain in the apical dual–chamber position (AP2) was –16.1 (–17.0; –10.9)% and –18.3 (–20.1; –15.0)% in the 2nd (U = 287.0, р = 0.016); in the apical three–chamber position (AP3) –15.2 (–17.7; –11.8)% and 18.3 (–20.1; –17.2)%, respectively (U = 258,5, p = 0.004); in the apical four–chamber position (AP4) –14.8 (–17.6; –11.8)% and –17.1 (–18.4; –15.5)%, respectively (U = 189.5, p = 0.000). GLS in the study groups was –15.4 (–16.8; –12.3)%
and –17.9 (–19.0; –16.5)%, respectively (U = 193.5, p = 0.000). The share of patients with GLS over –16% in group 1 after CHD surgical correction was 57%, which is significantly higher than in the group with non–surgical AV block (23%) (χ2 = 6.94, p = 0.008). Interventricular mechanical delay did not differ significantly between the groups, with values of 40.5 (15.0; 54.5) ms and 28.5 (7.0; 53.0) ms, respectively (U = 343.5, p = 0.236). Intraventricular dyssynchrony was more pronounced in group 1 and totaled 121.0 (99.0; 140.0) ms compared to 84.0 (63.0; 106.0) ms in group 2 (U = 192.0, p = 0.000). The width of the QRS complex was significantly greater in group 1 compared to group 2, with values of 140 (140; 160) ms and 140 (130; 140) ms, respectively (U = 302.0, p = 0.028). Conclusion. We found that patients with prolonged ventricular pacing after CHD surgical correction, compared with patients with non-surgical AV block, have significantly lower values of total and regional longitudinal strain, as well as more pronounced dyssynchrony, which indicates the presence of systolic myocardial dysfunction and LV remodeling in this population and suggests an increased risk of developing pacemaker-induced cardiomyopathy (PICM).

keywords: pacing, congenital heart defects, atrioventricular block, longitudinal strain, dyssynchrony.

for references: A. Harypau, I. Patsiayuk. LEft ventricular myocardial longitudinal strain and dyssynchrony in patients with ventricular pacing in the long-term postoperative period. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2023, vol. 7, no. 1, pp. 1768–1775.

1. Klaeboe L.G., Edvardsen T. Echocardiographic assessment of left ventricular systolic function. J Echocardiogr, 2019, vol. 17, no. 1, pp. 10-16. doi: 10.1007/s12574-018-0405-5.
2. Sanna G.D., Canonico M.E., Santoro C., Esposito R., Masia S.L., Galderisi M., Parodi G., Nihoyannopoulos P. Echocardiographic longitudinal strain analysis in heart failure: real usefulness for clinical management beyond diagnostic value and prognostic correlations? A comprehensive review. Curr Heart Fail Rep, 2021, vol. 18, no 5, pp. 290-303. doi: 10.1007/s11897-021-00530-1.
3. Palazzuoli A., Correale M., Iacoviello M., Gronda E. Does the measurement of ejection fraction still make sense in the HFpEF framework? What recent trials suggest. J Clin Med, 2023, vol. 12, no 2, pp. 693. doi:10.3390/jcm12020693.
4. Szymanski C., Lévy F., Tribouilloy C. Should LVEF be replaced by global longitudinal strain. Heart, 2014, vol. 100, no 21, pp. 1655-1656. doi: 10.1136/heartjnl-2014-306186.
5. Potter E., Marwick T.H. Assessment of left ventricular function by echocardiography: the case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging, 2018, vol. 11, no. 2(Pt 1), pp. 260-274. doi: 10.1016/j.jcmg.2017.11.017.
6. Pieske B., Tschöpe C., de Boer R.A., Fraser A.G., Anker S.D., Donal E., Edelmann F., Fu M., Guazzi M., Lam C.S.P., Lancellotti P., Melenovsky V., Morris D.A, Nagel E., Pieske-Kraigher E., Ponikowski P., Solomon S.D., Vasan R.S., Rutten F.H., Voors A.A., Ruschitzka F., Paulus W.J., Seferovic P., Filippatos G. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J, 2019, vol. 40, no 40, pp. 3297-3317. doi: 10.1093/
eurheartj/ehz641.
7. Sengeløv M., Jørgensen P.G., Jensen J.S., Bruun N.E., Olsen F.J., Fritz-Hansen T., Nochioka K., Biering-Sørensen T. Global longitudinal strain is a superior predictor of all-cause mortality in heart failure with reduced ejection fraction. JACC Cardiovasc Imag, 2015, vol. 8, no 12, pp. 1351-1359. doi: 10. 1016/j.jcmg.2015.0.013.
8. Vdovenko D.V., Libis R.A. Pokazateli deformacii miokarda i diastolicheskaya funkciya levogo zheludochka u bol’nyh hronicheskoj serdechnoj nedostatochnost’yu s sohranennoj frakciej vybrosa [Indicators of myocardial deformation and diastolic function of the left ventricle in patients with chronic heart failure with preserved ejection fraction]. Arterialnaya gipertenziya, 2018, vol. 24, no. 1, pp. 74-80. doi: 10.18705/1607-419X-2018-24-1-74-80. (in Russian).
9. Gricenko O.V., CHumakova G.A., Trubina E.V. Vozmozhnosti speckle trackingekhokardiografii dlya diagnostiki disfunkcii miokarda [Possibilities of speckle track ing echocardiography for diagnosing myocardial dysfunction]. CardioSomatika, 2021, vol. 12, no. 1, pp. 5-10. doi: 10.26442/22217185.2021.1.200756. (in Russian).
10. Kalam K., Otahal P., Marwick T.H. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart, 2014, vol. 100, no. 21, pp. 1673-1680. doi: 10.1136/ heartjnl-2014-305538.
11. Egbe A.C., Miranda W.R., Pellikka P.A., DeSimone C.V., Connolly H.M. Prevalence and prognostic implications of left ventricular systolic dysfunction in adults with congenital heart disease. J. Am Coll Cardiol, 2022, vol. 79, no. 14, pp. 1356-1365. doi: 10.1016/j.jacc.2022.01.040.
12. Egbe A.C., Miranda W.R., Anderson J.H., Pellikka P.A., Connolly H.M. Prognostic value of left ventricular global longitudinal strain in patients with congenital heart disease. Circ Cardiovasc Imaging, 2022, vol. 15, no. 12, pp. e014865. doi: 10.1161/CIRCIMAGING.122.014865.
13. Kachboura S., Ben Halima A., Fersi I., Marrakchi S., Zouaoui W., Kammoun I. Assessment of heart failure and left ventricular systolic dysfunction after cardiac pacing in patients with preserved left ventricular systolic function. Ann Cardiol Angeiol (Paris), 2008, vol. 57, no. 1, pp. 29-36. doi: 10.1016/j.ancard.2007.09.011.
14. Ahmed F.Z., Motwani M., Cunnington C., Kwok C.S., Fullwood C., Oceandy D., Fitchet A., Goode G.K., Luckie M., Zaidi A.M., Khattar R., Mamas M.A. One-month global longitudinal strain identifies patients who will develop pacing-induced left ventricular dysfunction over time: the pacing and ventricular dysfunction (PAVD) study. PLoS One, 2017, vol. 12, no. 1, pp. e0162072. doi: 10.1371/journal.pone.0162072.
15. Xu H., Li J., Bao Z., Xu C., Zhang Y., Liu H., Yang J. Early change in global longitudinal strain is an independent predictor of left ventricular adverse remodelling in patients with right ventricular apical pacing. Heart Lung Circ, 2019, vol. 28, no. 12, pp. 1780-1787. doi: 10.1016/j.hlc.2018.11.004.
16. Dawood M., Elsharkawy E., Abdel-Hay M.A., Nawar M. Predictors of pacing induced left ventricular dysfunction and cardiomyopathy assessed by three-dimensional echocardiography and speckle tracking strain. Egypt Heart J, 2021, vol. 73, no. 1, pp. 10. doi: 10.1186/s43044-021-00136-x.
17. Kim D-Y., Lkhagvasuren P., Seo J., Cho I., Hong G-R., Ha J-W., Shim C.Y. Left ventricular global longitudinal strain is associated with cardiovascular outcomes in patients who underwent permanent pacemaker implantation. Front Cardiovasc Med, 2021, vol. 8, pp. 705778. doi: 10.3389/fcvm.2021.705778.
18. Chin J.Y., Kang K.W., Park S.H., Choi Y.J., Jung K. T., Lee S., Youn H.J. Pre-implant global longitudinal strain as an early sign of pacing-induced cardiomyopathy in patients with complete atrioventricular block. Echocardiography, 2021, vol. 38, no. 2, pp. 175-182. doi: 10.1111/echo.14942.
19. Voigt J.U., Pedrizzetti G., Lysyansky P., Marwick T.H., Houle H., Baumann R., Pedri S., Ito Y., Abe Y., Metz S., Song J.H., Hamilton J., Sengupta P.P., Kolias T.J., d’Hooge J., Aurigemma G.P., Thomas J.D., Badano L.P. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur. Heart J Cardiovasc Imaging, 2015, vol. 16, no. 1, pp. 1-11. doi: 10.1093/ehjci/jeu184.
20. Negishi K., Negishi T., Kurosawa K., Hristova K., Popescu B.A., Vinereanu D., Yuda S., Marwick T.H. Practical guidance in echocardiographic assessment of global longitudinal strain. JACC Cardiovas. Imaging, 2015, vol. 8, pp. 489-492. doi: 10.1016/j.jcmg.2014.06.013.
21. Cazeau S., Bordachar P., Jauvert G., Lazarus A., Alonso C., Vandrell M.C., Mugica J., Ritter P. Echo-cardiographic modelling of cardiac dyssynchrony before and during multisite stimulation: a prospective study. Pacing Clin Electrophysiol, 2003, vol. 26, pp. 137-143. doi: 10.1046/j.1460-9592.2003.00003.x.
22. Pitzalis M.V., Iacoviello M., Romito R., Massari F., Rizzon B., Luzzi G., Guida P., Andriani A., Mastropasqua F., Rizzon P. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardiol, 2002, vol. 40, no. 9, pp. 1615-1622. doi: 10.1016/s0735-1097(02)02337-9.
23. Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L., Flachskampf F.A., Foster E., Goldstein S.A., Kuznetsova T., Lancellotti P., Muraru D., Picard M.H., Rietzschel E.R., Rudski L., Spencer K.T., Tsang W., Voigt J.U. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging, 2015, vol. 28, no. 1, pp. 1-39.e14. doi: 10.1016/j.echo.2014.10.003.
24. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Francesco Piepoli M., Price S., Rosano G.M.C., Ruschitzka F., Kathrine Skibelund A. ESC Scientific Document Group, 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J, 2021, vol. 42, no. 36, pp. 3599-3726. doi: 10.1093/eurheartj/ehab368.
25. Onishi T., Saha S.K., Delgado-Montero A. Global longitudinal strain and global circumfencial strain by speckle- tracking echocardiography and feature-tracking cardiac magnetic resonance imaging: comparison with left ventricular ejection fraction. J Am Soc Echocardiogr, 2015, vol. 28, no. 5, pp. 587-596. doi: 10.1016/j.echo.2014.11.018.
26. Kim J.H., Kang K.W., Chin J.Y., Kim T.S., Park J.H., Choi Y.J. Major determinant of the occurrence of pacing-induced cardiomyopathy in complete atrioventricular block: a multicentre, retrospective analysis over a 15-year period in South Korea. BMJ Open, 2018, vol. 8, no. 2, pp. e019048. doi: 10.1136/bmjopen-2017-019048.
27. Khurshid S., Liang J.J., Owens A., Lin D., Schaller R., Epstein A.E., Marchlinski F.E., Frankel D.S. Longer paced QRS duration is associated with increased prevalence of right ventricular pacing-induced cardiomyopathy. J Cardiovasc Electrophysiol, 2016, vol. 27, no. 10, pp. 1174-1179. doi: 10.1111/jce.13045.
28. Abdelmohsen Sayed M., Abd El Fatah Badran H., Khaled S., Effat Fakhry E. Predictors of right ventricular pacing-induced left ventricular dysfunction in pacemaker recipients with preserved ejection fraction. Stimulation induzierten linksventrikulären Dysfunktion bei Patienten mit Schrittmacher und erhaltener Ejektionsfraktion. Herzschrittmacherther
Elektrophysiol, 2022, vol. 33, no. 3, pp. 312-318. doi: 10.1007/s00399-022-00880-w.

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