The association between paced left ventricular activation time and cardiac reverse remodeling in heart failure
Xinmin Chen1, Jiayi Xu1, Yuqing Wu1
1Department of Cardiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
Longer left ventricular activation times (LVAT) in patients with heart failure and left bundle branch block were linked to poorer baseline cardiac function but did not impede long-term reverse remodeling. Recovery may take longer with extended LVAT.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Left bundle branch block (LBBB) complicates heart failure (HF) management.
- Left ventricular activation time (LVAT) is a potential marker for pacing effectiveness.
- The relationship between LVAT and cardiac remodeling in HF with LBBB is not well understood.
Purpose of the Study:
- To investigate the association between paced LVAT and baseline cardiac structure and function.
- To determine if longer LVAT correlates with impaired cardiac reverse remodeling in HF patients with LBBB.
Main Methods:
- Retrospective analysis of HF patients with LBBB undergoing left bundle branch pacing (LBBP).
- Patients grouped by paced LVAT.
- Echocardiographic parameters and NT-proBNP levels assessed at baseline and follow-up.
Main Results:
- Longer LVAT associated with larger left ventricular end-diastolic diameter (LVEDD) and lower ejection fraction (LVEF) at baseline.
- Significant improvement in LVEF and reduction in LVEDD and NT-proBNP post-LBBP across all groups.
- No significant correlation found between LVAT and the change in LVEF over time, though longer LVAT suggested slower initial recovery.
Conclusions:
- Paced LVAT is associated with baseline cardiac dysfunction in HF with LBBB.
- Longer LVAT does not appear to hinder overall cardiac reverse remodeling.
- Patients with longer LVAT may experience a delayed recovery of cardiac function.
Introduction:
The association between paced LVAT and cardiac structure and function at baseline, as well as whether longer LVAT is associated with worse cardiac reverse remodeling in patients with heart failure (HF) and left bundle branch block (LBBB) has not been well investigated. The purpose of this study is to investigate the association between paced LVAT and baseline echocardiographic parameters and cardiac reverse remodeling at follow-up.
Methods:
Patients with HF and LBBB receiving successful left bundle branch pacing (LBBP) from June 2018 to April 2023 were enrolled and grouped based on paced LVAT. NT-proBNP and echocardiographic parameters were recorded during routine follow-up. The relationships between paced LVAT and echocardiographic parameters at baseline and follow-up were analyzed.
Results:
Eighty-three patients were enrolled (48 males, aged 65 ± 9.8, mean LVEF 32.1 ± 7.5%, mean LVEDD 63.0 ± 8.5 mm, median NT-proBNP 1057[513-3158] pg/mL). The paced QRSd was significantly decreased (177 ± 17.9 vs. 134 ± 18.5, p < .001) and median paced LVAT was 80[72-88] ms. After a median follow-up of 12[9-29] months, LVEF increased to 52.1 ± 11.2%, LVEDD decreased to 52.6 ± 8.8 mm, and NT-proBNP decreased to 215[73-532]pg/mL. Patients were grouped based on paced LVAT: LVAT < 80 ms (n = 39); 80 ≤ LVAT < 90 ms (n = 24); LVAT ≥ 90 ms (n = 20). Patients with longer LVAT had larger LVEDD and lower LVEF (LVEDDbaseline: p < .001; LVEFbaseline: p = .001). The difference in LVEF6M was statistically significant among groups (p < .001) and patients with longer LVAT had lower LVEF6M, while the difference in LVEF1Y was not seen (p = .090). There was no significant correlation between ΔLVEF6M-baseline, ΔLVEF1Y-6M and LVAT respectively (ΔLVEF6M-baseline: p = .261, r = -.126; ΔLVEF1Y-6M: p = .085, r = .218).
Conclusion:
Long paced LVAT was associated with worse echocardiographic parameters at baseline, but did not affect the cardiac reverse remodeling in patients with HF and LBBB. Those with longer LVAT required longer time to recover.
