Association Between Global Longitudinal Strain and Pacing-Induced Cardiomyopathy: A Systematic Review and...

High right ventricular pacing burden is a well-established risk factor for the development of left ventricular dysfunction and pacing-induced cardiomyopathy (PICM). However, identification of post-implant patients at risk for PICM remains challenging. This meta-analysis evaluated the association between global longitudinal strain (GLS) by speckle tracking echocardiography (STE) and the risk of subsequent development of PICM in patients who undergo pacemaker implantation.

We searched the databases PubMed, Embase, and Web of Science for studies reporting an association between early (<1 month) and late (>1 month) post-implant GLS measurement and subsequent development of PICM on long-term follow-up. The search was not restricted to time or publication status. Results were reported as mean difference (MD) with 95% confidence intervals (CIs) and p values.

A total of 6 studies with 455 patients (74 with eventual PICM, 381 without PICM) met inclusion criteria. The mean follow-up was 15 months, mean age was 69.2 years, and 48.6% were men. The mean ventricular pacing burden was 88.8%. Both early post-implant GLS (MD 4.98, 95% CI 3.84-6.12; p < 0.01) and long-term post-implant GLS (MD 5.35, 95% CI 3.83-6.88; p < 0.01) were significantly reduced in patients who eventually developed PICM; a positive MD indicates a less negative (more impaired) GLS in the PICM group.

GLS values are significantly reduced both early and late after pacemaker implantation in patients who subsequently develop PICM. Impaired post-implant GLS measured by STE was associated with an increased risk of subsequently developing PICM. Whether GLS can be used to identify at-risk patients in clinical practice remains to be established in prospective studies.