Early Change in Global Longitudinal Strain is an Independent Predictor of Left Ventricular Adverse Remodelling in Patients With Right Ventricular Apical Pacing

Background: Right ventricular apical (RVA) pacing is related to adverse left ventricular (LV) remodelling. This study assessed changes in global longitudinal strain (GLS) after permanent RVA pacing, and investigated whether GLS at one month can predict later LV ejection fraction (LVEF) decline.

Methods: The study enrolled 68 patients with normal LVEF (≥50%) who underwent dual chamber pacemaker implantation for third-degree atrioventricular block. Global strains and LVEF were assessed using three-dimensional (3D) speckle tracking strain echocardiography (STE).

Results: At one month, GLS was significantly lower in those patients who developed pacing-induced LV dysfunction (PIVD), which was defined as a reduction in LVEF ≥5 percentage points at 12 months, than those who did not (-14.9±1.8 vs -16.1±1.7, p=0.014), although GLS was similar at baseline. In patients who developed PIVD, only GLS was significantly reduced at one month compared to baseline (-14.9±1.8 vs -16.6±1.2, p=0.022) whereas LVEF was not. Global longitudinal strain at one month was the only independent predictor for PIVD at 12 months on multivariate analysis (OR, 1.623; 95% CI, 0.986-2.210; p=0.009). Receiver operating characteristic (ROC) analysis showed that GLS at one month had a high predictive accuracy for the development of PIVD at 12 months, with an area under curve (AUC) of 0.88, 94% sensitivity, and 70% specificity.

Conclusions: Global longitudinal strain at one month after pacemaker implantation had high predictive accuracy for identifying subsequent development of PIVD. Global longitudinal strain may be an invaluable parameter to predict LV adverse remodelling following permanent RVA pacing.