Midrange ejection fraction as a risk factor for deterioration of cardiofunction after permanent pacemaker...

Area of Science:

• Cardiology
• Cardiac Electrophysiology
• Pacemaker Technology

Background:

• Permanent pacemaker (PPM) implantation is a common procedure for bradyarrhythmias.
• Assessing cardiac function post-PPM is crucial for patient management.
• The prognostic significance of midrange ejection fraction (mrEF) in this context requires further investigation.

Purpose of the Study:

• To investigate the association between mrEF and the risk of cardiac function deterioration (DCF) following dual-chamber PPM implantation.
• To identify other predictors of DCF in patients undergoing PPM implantation.

Main Methods:

• Prospective cohort study involving 879 patients with ejection fraction (EF) ≥ 40% indicated for PPM.
• Comprehensive baseline and 6-month follow-up assessments including clinical, biochemical, echocardiographic, and ECG parameters.
• Univariate and multivariable Cox regression analyses were employed to identify predictors of DCF.

Main Results:

• A total of 81 patients (9.2%) experienced DCF, defined as LVEF < 40% or increased NYHA class.
• Independent predictors of DCF included age ≥ 75 years, old myocardial infarction (OMI), mrEF, moderate mitral regurgitation, and right ventricular pacing ≥ 50%.
• Elevated NT-proBNP levels and paced QRS duration ≥ 180 ms were also identified as independent predictors.

Conclusions:

• Midrange ejection fraction (mrEF) is significantly associated with an increased risk of cardiac function deterioration after PPM implantation.
• Moderate mitral regurgitation and elevated NT-proBNP levels are identified as potential independent predictors of DCF.
• These findings highlight the importance of considering baseline EF and other cardiac parameters in risk stratification for PPM patients.