The impact and predictive value of left ventricular activation time on the mid-to long-term left ventricular function after pacemaker therapy in patients with heart failure
The impact and predictive value of left ventricular activation time on the mid-to long-term left ventricular function after pacemaker therapy in patients with heart failure
Objective:To investigate the impact of stimulus to left ventricular activation time(sti-LVAT)on the mid-to long-term prognosis of left ventricular function after pacemaker therapy in patients with heart failure.Methods:A retrospective analysis was conducted on 89 patients who underwent pacemaker implantation with a high ventricular pacing ratio at our hospital from January 2019 to May 2023.According to the pacing site,they were divided into the LBBAP group(n=42),RVSP group(n=13),and RVAP group(n=34).Differences in baseline data,intraoperative electrophysiological parameters,and postoperative 6-month left ventricular function parameters were compared among the three groups.Results:The LBBAP group had the shortest pacing QRSd during the procedure,followed by the RVSP group and RVAP group.Significant differences in unipolar imped-ance during the procedure were observed among the three groups(P=0.005).Compared to baseline,the LBBAP group had a significant decrease in LVEDD,LAD,and NT-proBNP after 6 months[LVEDD:(48.12±6.51)mm vs(50.45±7.96)mm,P=0.001;LAD:(40.05±5.92)mm vs(42.02±7.20)mm,P=0.002;NT-proBNP:219.50(89.75,472.50)pg/mL vs 1 166.50(683.75,2 125.00)pg/mL,P=0.001],and a significant increase in LVEF[(62.95±4.99)％vs(58.31±9.36)％,P＜0.001].The RVAP group had a significant in-crease in LAD[(42.82±5.24)mm vs(41.06±5.59)mm,P=0.009]and a significant decrease in LVEF[(56.91±7.18)％vs(60.38±7.13)％,P=0.041]after 6 months;there were no significant changes in LVEDD,LAD,and LVEF in the RVSP group after 6 months.During the procedure,the LBBAP group had the shortest sti-LVAT[(74.45±12.90)ms],followed by the RVSP group[(94.69±11.00)ms]and RVAP group[(100.21±11.44)ms],with significant differences among the three groups(P＜0.001).Linear regression anal-ysis showed that sti-LVAT was positively correlated with ln(NT-proBNP),LVEDD,and LAD after 6 months(r=0.674,0.512,0.400,P＜0.001),and negatively correlated with 6-month LVEF(r=-0.510,P＜0.001).Multivariate linear regression analysis showed that sti-LVAT could positively predict 6-month NT-proBNP(b=0.051,β=0.646,P＜0.001)and LVEDD values(b=0.157,β=0.423,P＜0.001).Conclusion:LBBAP can significantly improve left ventricular function and reduce ventricular remodeling after pacemaker therapy in pa-tients with heart failure.sti-LVAT has good predictive value for left ventricular function in patients with heart failure and a high ventricular pacing ratio.
关键词
左束支区域起搏/右室心尖部起搏/右室间隔部起搏/左室达峰时间/左心功能/心室重构
Key words
left bundle branch area pacing/right ventricular septum pacing/right ventricular apex pacing/left ventricular activation time/left ventricular function/ventricular remodeling
维普
万方数据