Association of Pulmonary Hypertension with Mortality in Incident Peritoneal Dialysis Patients

Background The prognostic value of pulmonary hypertension at the start of peritoneal dialysis (PD) in patient survival is unclear. Methods We conducted a retrospective study of incident patients who initiated PD therapy from January 2007 to December 2011, and followed up through June 2013. Pulmonary hypertension was defined as an estimated systolic pulmonary artery pressure (PAP) of ≥ 35 mm Hg using echocardiography. Clinical parameters and laboratory findings were compared between patients with and without pulmonary hypertension and a logistic regression model was elaborated. Patient outcomes (all-cause and cardiovascular mortality) were recorded during follow-up. Survival curves were constructed by the Kaplan-Meier method, and the influences of pulmonary hypertension on outcomes were analyzed by Cox regression models. Results Pulmonary hypertension was prevalent in 99 (16.0%) of the 618 patients studied. The independent risk factors for pulmonary hypertension were female (odds ratio [OR] = 2.12; 95% confidence interval [CI]: 1.29 – 3.46), left atrial diameter (OR = 1.15; 95% CI: 1.10 – 1.20), left ventricular ejection fraction (OR = 0.97; 95% CI: 0.95 – 0.99), and serum sodium (OR = 0.94; 95% CI: 0.89 – 0.99). Over a median follow-up of 29.4 months, 93 patients (15.0%) died, 59.1% of them due to cardiovascular disease. Kaplan-Meier survival analysis showed that patients with pulmonary hypertension had worse overall rates of survival and cardiovascular death-free survival than those without pulmonary hypertension. After multivariate adjustment, pulmonary hypertension was independently associated with increased risk for both all-cause and cardiovascular mortality, with hazard ratios (HRs) of 2.10 (95% CI: 1.35 – 3.27) and 2.60 (95% CI: 1.48 – 4.56), respectively. Conclusions The prevalence of pulmonary hypertension at the start of PD was common and associated with increased risk of both all-cause and cardiovascular mortality in incident PD patients.

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Impact of pulmonary hypertension on outcome in patients with moderate or severe tricuspid regurgitation

Open Heart ◽

10.1136/openhrt-2019-001104 ◽

2019 ◽

Vol 6 (2) ◽

pp. e001104 ◽

Cited By ~ 1

Author(s):

Sahrai Saeed ◽

Jenna Smith ◽

Karine Grigoryan ◽

Stig Urheim ◽

John B Chambers ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Tricuspid Regurgitation ◽

Left Ventricular ◽

Right Atrial ◽

Left Ventricular Ejection ◽

Systolic Pulmonary Artery Pressure ◽

Ventricular Ejection Fraction ◽

Cox Regression Analysis ◽

The Impact

ObjectivesThe true prevalence and disease burden of moderate or severe (significant) tricuspid regurgitation (TR) in patients undergoing routine echocardiography remains unknown. Our aim was to explore the prevalence of significant TR and the impact of pulmonary hypertension (PH) on outcome in a less selected cohort of patients referred to echocardiography.MethodsFrom 12 791 echocardiograms performed between January and December 2010, a total of 209 (1.6%) patients (72±14 years, 56% men) were identified with significant TR; 123 (0.96%) with moderate and 86 (0.67%) with severe TR. Median follow-up time was 80 months (mean 70±33 months). Systolic pulmonary artery pressure was derived from peak velocity of tricuspid regurgitant jet plus the right atrial pressure and considered elevated if ≥40 mm Hg (PH).ResultsDuring follow-up there were 123 (59%) deaths with no difference in mortality between moderate and severe TR (p=0.456). The death rates were 93 (67%) in patients with PH versus 30 (42%) without PH (p<0.001). PH was associated with lower event-free survival in moderate (log-rank, p<0.001), but not in severe TR (log-rank, p=0.133). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, reduced right ventricle S′, lower left ventricular ejection fraction at baseline, right atrium size and mitral valve replacement, PH remained a significant predictor of all-cause mortality (HR 2.22; 95% CI 1.41 to 3.47, p=0.001).ConclusionsModerate or severe TR was found in 1.6% of patients attending for routine echocardiograms. PH identified a high-risk subset of patients with moderate TR but not with severe TR.

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Suitability of new non-invasive predictors for combined risk assessment of sudden cardiac death in patients after myocardial infarction

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2014-4-164-177 ◽

2015 ◽

Vol 18 (4) ◽

pp. 164 ◽

Cited By ~ 1

Author(s):

V. A. Sulimov ◽

D. A. Tsaregorodtsev ◽

Ye. A. Okisheva

Keyword(s):

Risk Assessment ◽

Cardiovascular Mortality ◽

Predictive Value ◽

Cardiovascular Death ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Non Invasive ◽

Increased Risk

The purpose of the study was to improve the risk prediction of SCD in post-MI patients by comparing the informative value of new non-invasive SCD risk stratification factors (HRT, mTWA, DC) with the well-known factors (impaired HRV, low left ventricular ejection fraction (LVEF), ventricular arrhythmias) both alone and in combination. Holter monitoring (HM) with evaluation of the above factors and echocardiography with LVEF measurement were performed in 111 patients (84 males and 27 females) aged 64.1 10.5 years who had MI from 2 months to 36 years (mean 27 [9; 84] months) prior to admission. The follow-up period was 12 months. The endpoints included SCD and overall cardiovascular mortality. During follow-up 15 cases of SCD and 8 other cardiovascular deaths (5 repeated fatal MI and 3 lethal strokes) were registered. LVEF was the most significant predictor of overall mortality followed by DC, HRT, HRV, mTWA and QRS width. LVEF turned out to be the most significant risk factor for SCD followed by HRT, QRS width, DC, number of PVCs per day and mTWA. Noninvasive electrophysiological predictors showed the maximum SCD predictive value in patients with LVEF >40%, whereas at lower LVEF their predictive value was either decreased or completely lost. Combined risk assessment revealed that combination of HRT2 and increased mTWA caused a significantly increased risk of cardiovascular death (OR 30.7 (95% CI, 3.5-271.6), p <0.001) and especially from SCD (OR 63.3 (95% CI, 6.8-585.8), p <0.001) compared to any other combination including those with reduced LVEF. Thus, the evaluation of HRT, DC and mTWA during HM enables to define the population of post-MI patients with high risks of cardiovascular mortality and SCD. These predictors are most effective in combination, as well as in patients with LVEF >40%. The combination of HRT2 and mTWA <sub>100</sub> >53 mcV is associated with a maximum increased risk of cardiovascular death and SCD.

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Prognostic value of atrial fibrillation in patients with heart failure and different left ventricular ejection fraction: results of the multicenter RIF-CHF register

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4200 ◽

2021 ◽

Vol 26 (1) ◽

pp. 4200

Author(s):

I. V. Zhirov ◽

N. V. Safronova ◽

Yu. F. Osmolovskaya ◽

S. N. Тereschenko

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Ejection Fraction ◽

Cardiovascular Mortality ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Number Of Patients ◽

Increased Risk

Heart failure (HF) and atrial fibrillation (AF) are the most common cardiovascular conditions in clinical practice and frequently coexist. The number of patients with HF and AF is increasing every year.Aim. To analyze the effect of clinical course and management of HF and AF on the outcomes.Material and methods. The data of 1,003 patients from the first Russian register of patients with HF and AF (RIF-CHF) were analyzed. The endpoints included hospitalization due to decompensated HF, cardiovascular mortality, thromboembolic events, and major bleeding. Predictors of unfavorable outcomes were analyzed separately for patients with HF with preserved ejection fraction (AF+HFpEF), mid-range ejection fraction (AF+HFmrEF), and reduced ejection fraction (AF+HFrEF).Results. Among all patients with HF, 39% had HFpEF, 15% — HFmrEF, and 46% — HFrEF. A total of 57,2% of patients were rehospitalized due to decompensated HF within one year. Hospitalization risk was the highest for HFmrEF patients (66%, p=0,017). Reduced ejection fraction was associated with the increased risk of cardiovascular mortality (15,5% vs 5,4% in other groups, p<0,001) but not ischemic stroke (2,4% vs 3%, p=0,776). Patients with HFpEF had lower risk to achieve the composite endpoint (stroke+MI+cardiovascular death) as compared to patients with HFmrEF and HFrEF (12,7% vs 22% and 25,5%, p<0,001). Regression logistic analysis revealed that factors such as demographic characteristics, disease severity, and selected therapy had different effects on the risk of unfavorable outcomes depending on ejection fraction group.Conclusion. Each group of patients with different ejection fractions is characterized by its own pattern of factors associated with unfavorable outcomes. The demographic and clinical characteristics of patients with mid-range ejection fraction demonstrate that these patients need to be studied as a separate cohort.

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The use of peritoneal dialysis in heart failure: A systematic review

Peritoneal Dialysis International ◽

10.1177/0896860819895198 ◽

2020 ◽

Vol 40 (6) ◽

pp. 527-539 ◽

Cited By ~ 1

Author(s):

Chang Yin Chionh ◽

Anna Clementi ◽

Cheng Boon Poh ◽

Fredric O Finkelstein ◽

Dinna N Cruz

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Peritoneal Dialysis ◽

Hospital Admissions ◽

Diuretic Therapy ◽

Heart Association ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Heart failure (HF) is a major cause of morbidity and mortality. Extracorporeal (EC) therapy, including ultrafiltration (UF) and haemodialysis (HD), peritoneal dialysis (PD) and peritoneal ultrafiltration (PUF) are potential therapeutic options in diuretic-resistant states. This systematic review assessed outcomes of PD and compared the effects of PD to EC. A comprehensive search of major databases from 1966 to 2017 for studies utilising PD (or PUF) in diuretic-resistant HF was conducted, excluding studies involving patients with end-stage kidney disease. Data were extracted and combined using a random-effects model, expressed as odds ratio (OR). Thirty-one studies ( n = 902) were identified from 3195 citations. None were randomised trials. Survival was variable (0–100%) with a wide follow-up duration (36 h–10 years). With follow-up > 1 year, the overall mortality was 48.3%. Only four studies compared PD with EC. Survival was 42.1% with PD and 45.0% with EC; the pooled effect did not favour either (OR 0.80; 95% confidence interval (CI): 0.24–2.69; p = 0.710). Studies on PD in patients with HF reported several benefits. Left ventricular ejection fraction (LVEF) improved after PD (OR 3.76, 95%CI: 2.24–5.27; p < 0.001). Seven of nine studies saw LVEF increase by > 10%. Twenty-one studies reported the New York Heart Association status and 40–100% of the patients improved by ≥ 1 grade. Nine of 10 studies reported reductions in hospitalisation frequency and/or duration. When treated with PD, HF patients had fewer symptoms, lower hospital admissions and duration compared to diuretic therapy. However, there is inadequate evidence comparing PD versus UF or HD. Further studies comparing these modalities in diuretic-resistant HF should be conducted.

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NT-ProBNP and hsTnI: A Multistate Survival Analysis in Outpatients with Reduced Left-Ventricular Ejection Fraction

Cardiology ◽

10.1159/000488640 ◽

2019 ◽

Vol 142 (1) ◽

pp. 7-13

Author(s):

Gabriele Di Gesaro ◽

Giuseppa Caccamo ◽

Diego Bellavia ◽

Calogero Falletta ◽

Chiara Minà ◽

...

Keyword(s):

Ejection Fraction ◽

Troponin I ◽

Serum Levels ◽

Left Ventricular ◽

Clinical Event ◽

Left Ventricular Ejection ◽

Baseline Serum ◽

Ventricular Ejection Fraction ◽

Increased Risk

Heart failure (HF) with reduced ejection fraction (HFrEF) has a well-known epidemic relevance in western countries. It affects up to 1–2% of patients > 60 years and reaches a prevalence of 12% in octogenarian patients. The role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitive troponin I (hsTnI) in risk stratifying HFrEF patients has been established; at present, evidence is exclusively based on one-time assessments, and the prognostic usefulness of serial biochemical assessments in this population still remains to be determined. We prospectively recruited 226 patients with chronic HFrEF, who were all referred to the Outpatient Clinic of our institution from November 2011 through September 2014. Recruited patients underwent full clinical evaluation with complete history taking and physical examination as well as ECG, biochemical assessment, and standard 2D and Doppler flow echocardiography at the first visit, and then again at each visit during the follow-up, repeated every 6 months. During the follow-up period, cardiovascular (CV) death, which occurred in 16 patients, was not statistically correlated with gender (p = 0.088) or age (p = 0.1636); however, baseline serum levels of NT-proBNP, which were 3 times higher in deceased patients, were significantly related to this clinical event (p = 0.001). We found that NT-proBNP represents a strong and independent predictor of CV outcome; serum levels of hsTnI, which are significantly related to an increased risk of hospitalization, cannot properly predict the relative risk of CV mortality. Our study validates, eventually, the multimarker strategy, which reflects the complexity of the HF pathophysiology.

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Longer-term cardiac safety and outcomes of dose dense (dd) doxorubicin and cyclophosphamide (AC) followed by paclitaxel (T) and trastuzumab (H) with and without lapatinib (L) in patients (pts) with early breast cancer (BC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.167 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 167-167

Author(s):

Neil M. Iyengar ◽

Patrick Glyn Morris ◽

Sujata Patil ◽

Carol Chen ◽

Alyson Abbruzzi ◽

...

Keyword(s):

Early Stage ◽

Disease Free Survival ◽

Left Ventricular ◽

Phase Iii ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Phase Ii Studies ◽

Increased Risk ◽

Dose Dense

167 Background: The addition of H to chemotherapy has improved outcomes in HER2-positive early BC. This approach is associated with (w/) an increased risk (<4%) of congestive heart failure (CHF). Dose-dense (every 2 weeks) anthracycline-taxane therapy (Rx) improves survival compared to the every 3 week schedule and can be combined w/ anti-HER2 Rx w/ no increased risk of cardiotoxicity up to 36 months. Here we report the incidence of NYHA Class III/IV CHF in 2 phase II studies with longer follow-up. Methods: We conducted a retrospective review of pts w/ HER2 + early stage BC treated at MSKCC and DFCI on two trials: In trial A - pts received dd AC (60/600 mg/m2) x 4 → T (175mg/m2) x 4 (w/ pegfilgrastim) w/ H x 1 year. Trial B differed w/ use of weekly T (80mg/m2) x 12 and the addition of L (1000mg orally daily) x 1 year. Left ventricular ejection fraction (LVEF) was prospectively assessed by a multi-gated acquisition scan serially throughout Rx. Results: Trial A enrolled 70 pts and Trial B enrolled 95 pts w/ the median age of 46 years (range 27-73 years). Overall, the 5-year distant disease-free survival (DDFS) for trials A and B is 92% (95%Cl; 83-97%) and 89% (95%CI; 81-94%), respectively. The baseline median LVEF was 68% (range 52-81%). In total, 28 of 165 (17%) pts had pre-existing hypertension. Now at a median follow-up of 84 and 57 months respectively, only one (1.4%, 95%CI; 1.36-7.7%) and 4 (4.2%, 95%CI; 4.2-10.4%) pts developed CHF. Since our earlier report, 1 additional CHF event occurred (Trial B) at month 44. Conclusions: Longer follow-up of these 2 studies demonstrate that dd AC → TH with or without L is associated w/ a low risk of CHF. This is consistent w/ the long-term cardiac toxicity reported from the randomized phase III studies of H w/ conventionally scheduled anthracycline-based regimens (with or without taxanes). DDFS outcomes are also encouraging. Clinical trial information: NCT00591851 and NCT00482391.

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Comparison of ventricular tachyarrhythmia recurrence between ischemic cardiomyopathy and dilated cardiomyopathy: a retrospective study

PeerJ ◽

10.7717/peerj.5312 ◽

2018 ◽

Vol 6 ◽

pp. e5312 ◽

Cited By ~ 3

Author(s):

Chih-Yuan Fang ◽

Huang-Chung Chen ◽

Yung-Lung Chen ◽

Tzu-Hsien Tsai ◽

Kuo-Li Pan ◽

...

Keyword(s):

Secondary Prevention ◽

Dilated Cardiomyopathy ◽

Cardiovascular Mortality ◽

Ischemic Cardiomyopathy ◽

Ventricular Tachyarrhythmia ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

All Cause Mortality

BackgroundThe use of an implantable cardioverter-defibrillator (ICD) has been established as an effective secondary prevention strategy for ventricular tachycardia (VT)/ventricular fibrillation (VF). However, few reports discuss the difference in clinical predictors for recurrent VT/VF between patients with ischemic cardiomyopathy (ICM) and patients with dilated cardiomyopathy (DCM).MethodsFrom May 2004 to December 2015, 132 consecutive patients who had ICM (n= 94) or DCM (n= 38) and had received ICD implantation for secondary prevention were enrolled in this study. All anti-tachycardia events during follow-up were validated. The clinical characteristics and echocardiographic parameters were obtained for comparison. The incidence of recurrence of VT/VF, cardiovascular mortality, all-cause mortality, the change of left ventricular ejection fraction (LVEF) and LV volume were analyzed.ResultsAt a mean follow-up of 3.62 ± 2.93 years, 34 patients (36.2%) in the ICM group and 22 patients (57.9%) in the DCM group had a recurrence of VT/VF episodes (p= 0.032). The DCM group had a lower LVEF (p= 0.019), a larger LV end-diastolic volume (LVEDV) (p= 0.001), a higher prevalence of LVEDV >158 mL (p= 0.010), and a larger LV end-systolic volume (p= 0.010) than the ICM group. LVEDV >158 mL and no use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker were independent predictors of recurrences of VT/VF in ICM patients but not in DCM patients. There were no difference in cardiovascular mortality and all-cause mortality between the ICM and DCM patients.ConclusionThe DCM patients had a higher recurrence rate of VT/VF than did the ICM patients during long-term follow-up. An enlarged LV is an independent predictor of the recurrence of VT/VF in ICM patients receiving ICD for secondary prevention.

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85 Diuretics trajectories in dilated cardiomyopathy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab139.026 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Vincenzo Nuzzi ◽

Antonio Cannatà ◽

Paolo Manca ◽

Caterina Gregorio ◽

Giulia Barbati ◽

...

Keyword(s):

Dilated Cardiomyopathy ◽

Nyha Class ◽

Diuretic Therapy ◽

Left Ventricular ◽

Equivalent Dose ◽

Left Ventricular Ejection ◽

Class Iii ◽

Ventricular Ejection Fraction ◽

Kaplan Meier

Abstract Aims Diuretics in heart failure (HF) are commended to relieve symptoms at lowest dosage effective. Dilated cardiomyopathy (DCM) is a particular HF setting with several variables that may influence disease trajectory. We aimed to assess the long-term use of diuretics in DCM, the possibility of withdrawal and to explore the prognostic correlations. Methods and results All consecutive DCM patients enrolled from 1990 to 2018 were considered eligible. All the patients had available the information about the furosemide-equivalent dose at baseline and at follow-up evaluation within 24 months. Patients were categorized in stable (diuretic dose variation <50%), increasers (diuretics dose increase ≥50% or initiation of diuretic therapy), and decreasers (diuretics dose decrease ≥50% or never prescribed diuretics in the 24-months observation period). The prognostic role of the diuretics trajectory group was assessed with Kaplan Meier analysis and with a time-dependent multivariable model. The outcome measure was a composite of all-cause death/heart transplantation/HF hospitalization (ACD/HTx/HFH). 908 patients were included [mean age 50 ± 16, 70% male sex, 24% NYHA class III or IV, mean left ventricular ejection fraction (LVEF) 31 ± 9%, 66% treated with diuretics at baseline]. The furosemide-equivalent dose at enrolment had a linear association with the risk of outcome. Compared to other groups, decreaser patients were younger, had less HF symptoms, higher LVEF and more dilated left atrium. Decreasers had a lower prescription rate of diuretics and less frequent indication to renin-angiotensin inhibitors and mineralocorticoid receptors antagonists. Over a median follow-up of 122 (62–195) months decreasers had the lowest incidence of outcome, followed by stable, while increasers had the worst outcome (P < 0.001). After adjustment for other prognosticators, compared to stable patients, decreasers had a reduced risk of ACD/HTx/HFH [HR: 0.497 (95% CI: 0.337–0.731)] while increasers had the highest risk of adverse outcome [HR: 2.027 (95% CI: 1.254–3.276)]. Similarly, amongst patients taking diuretics at baseline, the diuretics withdrawal was in independent outcome predictor. The only multivariable predictors of diuretics withdrawal were younger age and lower furosemide-equivalent dose at enrolment. Conclusions In DCM patients the diuretics dose at baseline is a strong prognosticator. Diuretics dose reduction or its withdrawal provides a prognostic benefit on hard outcome. Diuretics tapering in selected patients should be considered in the short-term follow-up to improve DCM prognosis.

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The left atrium remodeling is associated with adverse outcomes in unoperated degenerative aortic stenosis

Clinical Practice ◽

10.17816/clinpract09212-19 ◽

2018 ◽

Vol 9 (2) ◽

pp. 12-19 ◽

Cited By ~ 1

Author(s):

V. I. Safaryan ◽

I. V. Zotova ◽

T. A. Tipteva ◽

O. S. Koroleva ◽

D. A. Zateyshchikov

Keyword(s):

Aortic Stenosis ◽

Left Atrium ◽

Roc Curves ◽

Left Ventricular ◽

Adverse Outcomes ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Kaplan Meier ◽

Increased Risk ◽

General Mortality

Degenerative aortic stenosis (DAS) may be accompanied by remodeling of the left atrium (LA). The aim of the study was to assess the effect of the morpho-functional parameters of the LA remodeling on the prognosis of patients with DAS. The prospective study included 383 patients (men – 33.9% of patients), aged 78.9 ± 0.40 years, with DAS (mild – 18.3%, moderate – 30.8%, severe – 50.9%). The patients did not undergo a surgical correction of the defect. The LA morpho-functional state was estimated by the LA size/volume and the ratio of the rate of the transmitral flow to the rate of the early diastolic movement of the fibrous mitral valve ring (E/e ratio). The average follow-up period was 603.9 ± 24.57 days. The general mortality was assessed. The information on the outcomes was collected by telephone contacts. Multivariate Сox-regression analyses showed that the LA remodeling was independently associated with the death risk: an increase in the LA size ≥45 mm (ОR 1.6, CI 1.06-2.37, р=0.026) and an increase in the Е/е ratio >15 (ОR 1.6, CI 1.08-2.39, р=0.021). Another risk factor was a decrease in the creatinine clearance <45 ml/min (ОR 1.7, CI 1.10-2.60, р=0.016), area of the aortic valve (ОR 0.4, CI 0.26-0.74, р=0.002) and a decrease in the left ventricular ejection fraction <40% (ОR 1.7, CI 1.02-2.71, р=0.042). The Kaplan-Meier survival analysis showed that the E/e ratio>15 and the LА size ≥45 mm were statistically significantly associated with an increased risk of the general mortality (р<0.0001, LogRank=14.5 and р<0.0001, LogRank=18.2, respectively). The areas under the ROC curves for the increased LA size ≥45 mm and the E/e ratio>15 were 0.62 and 0.61, respectively. Thus, the indices of the LA remodeling – the LA size ≥45 mm and the E/e ratio > 15 – are associated with a poor outcome in patients with DAS.

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Abstract 16813: The Prevalence and Predictors of Pacing-Induced Cardiomyopathy (PICM) in Younger Patients

Circulation ◽

10.1161/circ.142.suppl_3.16813 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Dan L Li ◽

Zachary Yoneda ◽

Tariq Z Issa ◽

Jay A Montgomery ◽

Ben B Shoemaker

Keyword(s):

Multivariate Analysis ◽

Left Ventricular ◽

Interquartile Range ◽

Older Age ◽

Left Ventricular Ejection ◽

Ventricular Pacing ◽

Ventricular Ejection Fraction ◽

Younger Patients ◽

Increased Risk

Background: Pacing-induced cardiomyopathy (PICM) has been increasingly recognized as a cause of heart failure in patients with pacemakers. Thus far, clinical trials and observational studies of PICM have largely included elderly patients with mean age > 70 years. The prevalence and predictors of PICM in younger patients (age ≤ 59 years) after pacemaker implantation are not known. Methods: We retrospectively studied the prevalence and predictors of PICM in younger adults (18-59 years) who received single ventricular chamber or dual chamber pacemakers at Vanderbilt University Medical Center from 1986-2015. Patients without documented ventricular pacing burden, and patients with baseline left ventricular ejection fraction (LVEF) < 30% were excluded. PICM was defined as LVEF drop of ≥ 10% and LVEF < 50% during follow up in the setting of significant right ventricular pacing (≥ 20%), without alternative explanations for cardiomyopathy. Univariate and multivariable Cox proportional hazards regression models were utilized to study the factors associated with hazard of developing PICM. Results: A total of 325 patients were included in the study. 182 patients had high ventricular pacing (≥ 20%), which was associated with pre-existing atrial fibrillation (AF) and reduced baseline LVEF in addition to atrioventricular block (AVB) in the multivariate analysis. During the median follow up duration of 11.5 (Interquartile range 7 - 17) years, 38 patients (11.7%) developed PICM (1.3 per 100 patient-year). The median time to the development of PICM was 5 (Interquartile range 2 - 10) years. Older age (HR 2.5 for age ≥ 50 years, P = 0.013), reduced baseline LVEF (HR 2.4, P = 0.022), and AVB (HR 2.7, P = 0.007) were associated with an increased risk of PICM in the multivariate analysis. Furthermore, pre-existing AF was associated with an increased risk of PICM in patients without pre-implant AVB (HR 8.8 compared to the absence of both AF and AVB, P = 0.039). Conclusion: The incidence of PICM in young patients was low in this cohort of younger patients. Older age, baseline reduced LVEF, and AVB were associated with an increased risk of PICM in the young patient cohort. AF was associated with an increased risk of PICM in a subset of patients without pre-existing AVB at implant.

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