Can left ventricle mass index predict pacemaker-induced cardiomyopathy in patients with dual chamber permanent pacemakers implanted due to complete atrioventricular block?

Background

Pacing induced cardiomyopathy (PICM) occurs due to high-burden right ventricular pacing. In patients with complete atrioventricular (AV) block, it is presumed to have a higher burden of right ventricular pacing. There is a lack of data regarding the relationship between PICM and pre-implantation left ventricular mass index (LVMI).

Purpose

This study aims to investigate the effect of LVMI on PICM in patients with implanted dual chamber permanent pacemakers (PPM) due to complete AV block.

Methods

PPM implanted 577 patients were divided into three groups according to admission LVMI. Mean duration of follow-up was 57±38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the groups. The independent predictors of PICM incidence and the effect LVMI on PICM were evaluated.

Results

Age, post-implantation QRS duration, left atrium anteroposterior diameter and LVMI were determined to predict long-term PICM. After adjustment for confounding baseline variables, tertile with highest LVMI had 1.9 times higher rates of long-term PICM compared to tertile with lowest LVMI, which was used as the reference group. A ROC analysis showed that the optimal cut-off value of the LVMI to predict long-term PICM was 109.8 mg/m2 with 71% sensitivity and 62% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p<0.001),

Conclusion

Pre-implantation LVMI plays an important prognostic role in predicting PICM in patients with implanted dual chamber PPM due to complete AV block.

Funding Acknowledgement

Type of funding sources: None.

Evaluating systemic immune-inflammation index in patients with implantable cardioverter defibrillator for heart failure with reduced ejection fraction

Background

Pro-inflammatory pathways play a serious role in the follow-up of patients with intracardiac defibrillator (ICD) for heart failure reduced with ejection fraction (HFrEF). A newly defined index, which is named as systemic immune-inflammation index (SII), has been recently reported to have prognostic value in patients with cardiovascular disease.

Purpose

The aim of this investigation is to evaluate the value of SII in terms of its association with long-term mortality and appropriate ICD therapy during in 10-year follow-up.

Methods

This retrospective study included 1011 patients with ICD for HFrEF. The study population was divided into two groups according to optimal cut-off value of SII to predict long-term mortality. The long-term prognostic impact of SII on these patients were evaluated in terms of mortality and appropriate ICD therapy.

Results

A receiver operating characteristic curve analyses of systemic immune-inflammation index, platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio in long-term mortality and appropriate intracardiac defibrillator therapy for patients intracardiac defibrillator for heart failure reduced with ejection fraction were presented in Figure 1A and 1B respectively. The patients with higher SII had significantly higher long-term mortality and appropriate ICD therapy. After adjustment for all confounding factors, the long-term mortality had 5.1 higher rates at higher SII. (95% CI: 2.9–8.1). The long-term appropriate ICD therapy also had 2.0 higher rates at higher SII (95% CI: 1.4–3.0). Kaplan Meier survival analysis of patients according to the systemic immune-inflammation index was presented in Figure 2.

Conclusion

SII, calculated using neutrophil, platelet, and lymphocyte counts, may be an independent predictive marker for both long-term mortality and appropriate ICD therapy in patients with HFrEF.

Funding Acknowledgement

Type of funding sources: None.