Strain echocardiography in predicting LV dysfunction in RV apical pacing.

Area of Science:

• Cardiology
• Medical Imaging
• Electrophysiology

Background:

• Right ventricular (RV) pacing is linked to reduced left ventricular (LV) systolic function, potentially due to pacing-induced dyssynchrony.
• Heart failure prevalence post-RV pacing is significant, reported between 31±3%.

Purpose of the Study:

• To evaluate the utility of strain imaging for early detection of LV dysfunction in patients undergoing RV apical pacing.
• To identify factors associated with pacing-induced cardiomyopathy.

Main Methods:

• Sixty subjects with high-grade atrioventricular block (AV block) and Complete Heart Block (CHB) underwent 2D echocardiography and strain imaging at baseline, 1 month, and 12 months.
• Longitudinal strain (GLS) was measured using cardiac wall motion quantification (CMQ) software.
• Pacing-induced cardiomyopathy was defined as LVEF <45%.

Main Results:

• No baseline LV dysfunction was observed.
• At 1 month, 18 patients showed a low GLS score (< -14.5).
• By 1 year, all 18 patients with low GLS developed LV dysfunction on 2D echocardiography. Pacing-induced cardiomyopathy was associated with high-grade AV block and pacemaker dependency, and heart failure, but not other comorbidities.

Conclusions:

• Strain imaging, specifically GLS, enables early detection of LV dysfunction in RV apical pacing patients.
• Early identification facilitates management of pacing-induced cardiomyopathy, particularly in pacemaker-dependent individuals.