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Early Detection of Pacing-Induced Cardiomyopathy Using MicroRNA-208b-3p and MicroRNA-9: A Prospective Cohort Analysis

Onoufrios Malikides1,2, Aleksi Sallo1, Andria Papazachariou1,3

  • 1Medical School, University of Crete, 71003 Heraklion, Greece.

Genes
|January 28, 2026
PubMed
Abstract

Insights

Dynamic changes in microRNAs (miRs) like miR-208b-3p and miR-9 in peripheral blood mononuclear cells (PBMCs) can predict pacing-induced cardiomyopathy (PiCM) early. These miRs, along with left ventricular global longitudinal strain (LV-GLS), show promise as biomarkers for PiCM.

Area of Science:

  • Cardiology
  • Molecular Biology
  • Biomarker Discovery

Background:

  • Pacing-induced cardiomyopathy (PiCM) is a serious complication of chronic right ventricular pacing (RVP), leading to left ventricular (LV) dysfunction and heart failure.
  • MicroRNAs (miRs) are key regulators of gene expression involved in ventricular remodeling.
  • Early identification of patients at risk for PiCM is crucial for timely intervention.

Purpose of the Study:

  • To investigate dynamic changes in miRs within peripheral blood mononuclear cells (PBMCs) as potential early predictive biomarkers for PiCM.
  • To assess the relationship between miR expression levels and echocardiographic parameters in patients undergoing pacemaker implantation.

Main Methods:

  • A prospective, single-center cohort study involving 126 adult patients undergoing pacemaker implantation.
  • Assessment of clinical characteristics, echocardiographic parameters (including LVEF and LV-GLS), and expression levels of miR-208b-3p and miR-9 in PBMCs immediately and 3 months post-implantation.
  • PiCM defined as a ≥10% reduction in LVEF at one year; statistical analyses included correlation, ROC curve, and multivariate regression.

Main Results:

  • 11.1% of patients developed PiCM. Those who developed PiCM showed significant 3-month changes in miR-208b-3p and miR-9 expression compared to the non-PiCM group.
  • Multivariate analyses identified 3-month changes in LV-GLS, miR-208b-3p, and miR-9 as predictors of PiCM.
  • ROC analyses indicated good predictive ability for Δ3LV-GLS, Δ3log miR-208b-3p, and Δ3log miR-9, suggesting their utility in early PiCM detection.

Conclusions:

  • Dynamic changes in miR-208b-3p and miR-9 expression in PBMCs, alongside early LV-GLS deterioration, precede the development of overt LV systolic dysfunction in PiCM.
  • These miRs demonstrate potential as novel, non-invasive early predictive biomarkers for pacing-induced cardiomyopathy.
Keywords:
biomarkersglobal longitudinal strainmiR-208-3pmiR-9pacing-induced cardiomyopathy

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