Evaluation of left ventricular systolic function and synchrony in advanced atrioventricular block patients with heart failure with preserved ejection fraction after left bundle branch area pacing by real-time three-dimensional echocardiography

doi:10.3877/cma.j.issn.1672-6448.2023.04.009

Abstract

Abstract:

Objective

To evaluate the changes of left ventricular function and synchrony in advanced atrioventricular block (AAVB) patients with heart failure with preserved ejection fraction (HFpEF) after left bundle branch area pacing (LBBAP) using real-time three-dimensional echocardiography (RT-3DE).

Methods

A total of 45 AAVB patients with pacemaker implantation and LBBAP pacing at People's Hospital of Liaoning Province from December 2020 to August 2021 were enrolled. According to whether they were combined with HFpEF, the patients were divided into either an AAVB without HFpEF group (29 cases) or an AAVB with HFpEF group (16 cases). Echocardiography was used to obtain ultrasound parameters 3 days and 1 month after surgery, and RT-3DE was performed to obtain three-dimensional parameters, including left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), standard deviation of the minimum systolic volume time (Tmsv16-SD), and maximum time difference (Tmsv16-Dif) of the 16 segments of the left ventricle after heart rate correction. The improvement of left ventricular systolic function and synchronization between the two groups were compared 3 days and 1 month after surgery.

Results

Compared with the values obtained at 3 days after operation, LAD, LAVI, LVEDD, E, e', E/e', LVEDV, LVESV-3D, LVSV, LVEF, Tmsv-16-SD, and Tmsv16-Dif at 1 month after operation did not differ significantly in the AAVB without HFpEF group (P＞0.05). Compared with the values obtained at 3 days after operation, LAD, LAVI, LVEDD, E, LVEDV, LVESV, LVSV, and LVEF at 1 month after operation did not differ significantly in the AAVB with HFpEF group (P＞0.05), but e' increased significantly and E/e', Tmsv16-SD, and Tmsv16-Dif decreased significantly (P＜0.05). Pearson correlation analysis showed that postoperative NT-proBNP levels at three days and one month after LBBBAP in AAVB patients were positively correlated with Tmsv16-SD and Tmsv16-Dif (r=0.395, P=0.032; r=0466, P=0.007).

Conclusion

As a new physiological pacing mode, LBBAP can effectively improve the left ventricular diastolic function and synchronization in patients with AAVB and HFpEF one month after surgery. The effect is more significant in AAVB patients with HFpEF than in those without.

Key words: Heart failure, Left bundle branch area pacing, Atrioventricular block, Three-dimensional echocardiography

Ying Li, Shaoqing Pan, Mingyan Ding, Dandan Sun, Haibo Qu, Peipei Hou, Fang Zhu. Evaluation of left ventricular systolic function and synchrony in advanced atrioventricular block patients with heart failure with preserved ejection fraction after left bundle branch area pacing by real-time three-dimensional echocardiography[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(04): 430-436.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.04.009

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I04/430

Figures/Tables 7

组别	例数	男性（例）	年龄（岁， $x ¯$ ±s）	身高（m， $x ¯$ ±s）	体重（kg， $x ¯$ ±s）	体表面积（m²， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）
AAVB无HFpEF组	29	16	71.07±12.00	1.67±7.09	69.78±12.19	1.76±0.17	25.17±4.50
AAVB伴HFpEF组	16	10	74.50±13.19	1.67±8.43	72.07±10.36	1.79±0.17	25.63±2.87
统计值		χ²=0.976	t=-0.838	t=-0.363	t=0.600	t=0.626	t=0.344
P值		0.260	0.407	0.718	0.552	0.535	0.733
组别	例数	高血压［例（%）］	糖尿病［例（%）］	心房颤动［例（%）］	冠心病［例（%）］	术前QRS （ms， $x ¯$ ±s）	术前NT-proBNP（ng/L， $x ¯$ ±s）
AAVB无HFpEF组	29	16（55.2）	6（20.7）	3（10.3）	9（31.0）	114.15±8.73	337.70±210.55
AAVB伴HFpEF组	16	10（62.5）	4（25.0）	5（31.3）	10（62.5）	114.86±8.96	2433.43±1874.95
统计值		χ²=0.228	χ²=6.889	χ²=18.689	χ²=11.800	t=-2.63	t=-5.81
P值		0.192	0.124	＜0.001	＜0.001	0.794	＜0.001

组别	例数	男性（例）	年龄（岁， $x ¯$ ±s）	身高（m， $x ¯$ ±s）	体重（kg， $x ¯$ ±s）	体表面积（m²， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）
AAVB无HFpEF组	29	16	71.07±12.00	1.67±7.09	69.78±12.19	1.76±0.17	25.17±4.50
AAVB伴HFpEF组	16	10	74.50±13.19	1.67±8.43	72.07±10.36	1.79±0.17	25.63±2.87
统计值		χ²=0.976	t=-0.838	t=-0.363	t=0.600	t=0.626	t=0.344
P值		0.260	0.407	0.718	0.552	0.535	0.733
组别	例数	高血压［例（%）］	糖尿病［例（%）］	心房颤动［例（%）］	冠心病［例（%）］	术前QRS （ms， $x ¯$ ±s）	术前NT-proBNP（ng/L， $x ¯$ ±s）
AAVB无HFpEF组	29	16（55.2）	6（20.7）	3（10.3）	9（31.0）	114.15±8.73	337.70±210.55
AAVB伴HFpEF组	16	10（62.5）	4（25.0）	5（31.3）	10（62.5）	114.86±8.96	2433.43±1874.95
统计值		χ²=0.228	χ²=6.889	χ²=18.689	χ²=11.800	t=-2.63	t=-5.81
P值		0.192	0.124	＜0.001	＜0.001	0.794	＜0.001

参数	AAVB无HFpEF组（n=29）				AAVB伴HFpEF组（n=16）
参数	术后3 d	术后1个月	t值	P值	术后3 d	术后1个月	t值	P值
NT-proBNP（ng/L）	316.91±214.19	298.46±198.34	0.340	0.735	2230.03±500.39	1637.81±455.31	3.501	0.001
起搏QRS（ms）	113.38±9.87	113.01±9.32	0.150	0.881	114.06±8.73	113.13±9.27	0.295	0.770
LAD（mm）	39.37±3.88	39.07±3.47	0.434	0.671	45.81±5.81	45.13±5.49	0.344	0.733
LAVI（mL/m²）	27.82±3.38	27.62±3.22	0.477	0.635	34.12±3.01	33.69±2.16	0.466	0.645
LVEDD（mm）	47.52±3.93	47.32±3.41	0.291	0.772	50.43±4.07	50.44±3.79	0.451	0.655
E（cm/s）	82.81±24.51	84.83±24.79	0.140	0.889	97.94±23.25	96.81±22.61	0.139	0.891
e'（cm/s）	8.22±0.79	8.44±0.79	-1.086	0.282	6.22±1.15	7.84±0.73	-4.749	＜0.001
E/e'	10.43±3.32	10.05±3.17	0.449	0.655	16.19±4.30	12.41±2.79	2.951	0.006
LVEDV（ml）	102.52±20.44	100.00±19.18	0.484	0.631	117.38±25.54	114.25±25.84	0.344	0.733
LVESV（ml）	43.77±7.72	42.64±7.26	0.575	0.567	51.62±11.37	50.02±11.75	0.392	0.698
LVSV（ml）	58.74±13.42	57.36±12.62	0.405	0.687	65.75±14.51	64.23±14.56	0.296	0.769
LVEF（%）	57.07±2.73	57.07±2.13	-0.096	0.924	56.21±1.93	56.25±2.49	-0.317	0.753
Tmsv16-SD（%）	2.42±0.63	2.29±0.62	1.394	0.174	5.09±0.77	4.20±0.65	3.209	0.006
Tmsv16-Dif（%）	9.34±1.97	9.28±1.97	-0.440	0.663	21.91±6.25	17.81±3.75	2.541	0.023

References 21

1	中华医学会心血管病学分会心力衰竭学组, 中国医师协会心力衰竭专业委员会, 中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志, 2018, 46(10): 760-789.
2	陈莹, 董颖雪, 刘飞, 等. 心室起搏依赖的心力衰竭患者应用希氏束起搏与传统起搏对心脏功能影响的对比研究[J]. 中国循环杂志, 2020, 35(5): 468-474.
3	Sharma PS, Vijayaraman P, Ellenbogen KA. Permanent His bundle pacing: shaping the future of physiological ventricular pacing [published correction appears in Nat Rev Cardiol[J]. Nat Rev Cardiol, 2020, 17(1): 22-36.
4	Chen K, Li Y, Dai Y, et al. Comparison of electrocardiogram characteristics and pacing parameters between left bundle branch pacing and right ventricular pacing in patients receiving pacemaker therapy[J]. Europace, 2019, 21(4): 673-680.
5	Vaduganathan M, Michel A, Hall K, et al. Spectrum of epidemiological and clinical findings in patients with heart failure with preserved ejection fraction stratified by study design: a systematic review[J]. Eur J Heart Fail, 2016, 18(1): 54-65.
6	Kim MN, Park SM. Current status of pharmacologic and nonpharmacologic therapy in heart failure with preserved ejection fraction[J]. Heart Fail Clin, 2021, 17(3): 463-482.
7	Modin D, Biering-Sørensen SR, Møgelvang R, et al. Prognostic importance of left ventricular mechanical dyssynchrony in predicting cardiovascular death in the general population[J]. Circ Cardiovasc Imaging, 2018, 11(10): e007528.
8	Santos AB, Kraigher-Krainer E, Bello N, et al. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction[J]. Eur Heart J, 2014, 35(1): 42-47.
9	Lee AP, Zhang Q, Yip G, et al. LV mechanical dyssynchrony in heart failure with preserved ejection fraction complicating acute coronary syndrome[J]. JACC Cardiovasc Imaging, 2011, 4(4): 348-357.
10	Liu W, Hu C, Wang Y, et al. Mechanical synchrony and myocardial work in heart failure patients with left bundle branch area pacing and comparison with biventricular pacing[J]. Front Cardiovasc Med, 2021, 8: 727611.
11	Su L, Wang S, Wu S, et al. Long-term safety and feasibility of left bundle branch pacing in a large single-center study[J]. Circ Arrhythm Electrophysiol, 2021, 14(2): e009261.
12	Huang W, Su L, Wu S, et al. A novel pacing strategy with low and stable output: pacing the left bundle branch immediately beyond the conduction block[J]. Can J Cardiol. 2017, 33(12): 1736.e1-1736.e3.
13	Sun Z, Di B, Gao H, et al. Assessment of ventricular mechanical synchronization after left bundle branch pacing using 2-D speckle tracking echocardiography[J]. Clin Cardiol, 2020, 43(12): 1562-1572.
14	Li X, Li H, Ma W, et al. Permanent left bundle branch area pacing for atrioventricular block: Feasibility, safety, and acute effect[J]. Heart Rhythm, 2019, 16(12): 1766-1773.
15	黄於娟, 孙立平, 蒋芳勇, 等. 左束支区域起搏与右心室低位间隔部起搏对永久性心脏起搏器植入术患者心功能影响的对比研究[J]. 实用心脑肺血管病杂志, 2021, 29(3): 68-74.
16	Li X, Qiu C, Xie R, et al. Left bundle branch area pacing delivery of cardiac resynchronization therapy and comparison with biventricular pacing[J]. ESC Heart Fail, 2020, 7(4): 1711-1722.
17	Huang W, Su L, Wu S, et al. Benefits of permanent his bundle pacing combined with atrioventricular node ablation in atrial fibrillation patients with heart failure with both preserved and reduced left ventricular ejection fraction[J]. J Am Heart Assoc, 2017, 6(4): e005309.
18	Ye Y, Zhang K, Yang Y, et al. Feasibility and safety of both His bundle pacing and left bundle branch area pacing in atrial fibrillation patients: intermediate term follow-up[J]. J Interv Card Electrophysiol, 2021. [published online ahead of print, 2021 Mar 15].
19	Yang L, Wang J, Wang Y, et al. Results of performing or not cardiac resynchronization therapy for live assessment of LV function and mechanical systole synchrony using gated myocardial perfusion imaging and real‐time three‐dimensional echocardiography. Seven months follow‐up[J]. Hell J Nucl Med, 2017, 20: 247‐250.
20	Cai B, Huang X, Li L, et al. Evaluation of cardiac synchrony in left bundle branch pacing: Insights from echocardiographic research [J]. J Cardiovasc Electrophysiol, 2020, 31(2): 560-569.
21	Heckman LIB, Luermans JGLM, Curila K, et al. Comparing ventricular synchrony in left bundle branch and left ventricular septal pacing in pacemaker patients[J]. J Clin Med, 2021, 10(4): 822.

[1]	Xining Wu, Yunshu Ouyang, Yixiu Zhang, Hua Meng, Zhonghui Xu, Peipei Zhang, Ke Lyu. Application of fetal echocardiography in prenatal management of fetuses with positive maternal anti-SSA/Ro-SSB/La antibodies [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1056-1060.
[2]	Yuwei Bao, Ying Zhu, Kangchao Zheng, Wei Zhou, Yani Liu, Youbin Deng. Value of artificial intelligence based three-dimensional echocardiography in quantitative evaluation of right ventricular function [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(12): 1329-1335.
[3]	Yifan Liu, Di Gao, Jia Dong, Kaiyuan Zhu, Xin Pan, Fenglei Zhang, Dachun Xu, Chunxi Yan. Prognostic value of soluble suppression of tumorigenicity-2 in hospitalized patients with acute heart failure [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(01): 13-19.
[4]	Hui Pang, Zhenkun Zong, Peng Guo, Peng Wei, Lin Hao. Application of the CHA₂DS₂-VASc score in predicting thromboembolic risk in patients with heart failure [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2022, 15(04): 285-290.
[5]	Shanshan Zheng, Zhe Zheng, Jie Huang, Zhongkai Liao, Yunhu Song, Xiaonan Fang, Sheng Liu. Efficacy of intra-aortic balloon pump as bridging therapy for heart transplantation in patients with advanced heart failure and pulmonary hypertension [J]. Chinese Journal of Transplantation(Electronic Edition), 2022, 16(05): 277-284.
[6]	Xuefeng Sun. RAAS inhibitors in the treatment of patients with chronic kidney disease accompanied by heart failure [J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2022, 11(06): 301-306.
[7]	Linyang Yu, Meiying Wang, Jianbin Li, Xiaobin Lou, Siyuan Xie, Zhizhong Ma, Haiying Qi, Jia Li. Characteristics of pulmonary arterial pressure and cardiac morphology and function in children with pneumonia and right heart failure in a high altitude area [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(05): 535-544.
[8]	Zhen Wang, Xiaoyue Yang, Kangkang Su, Chaoyang Wang, Shaojie Li, Shuxia Chen, Jian Gu. Progress in understanding of prognostic impact of beta-blockers on patients with heart failure and atrial fibrillation [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 479-482.
[9]	Zhiming Wang, Yueqing Huang, Qinghua Ma, Weihai Chen, Qin Sun, Renlin Yin, Yanming Wu, Fulong Ye, Hua You, Min Huang. Application of "specialty-general practice" integrated management in elderly patients with non-valvular atrial fibrillation and heart failure: a propensity score matching study [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(12): 1188-1193.
[10]	Mingxue Li, Zimo Li, Jianli Tian. Relationship between blood pressure and heart failure: research status and challenges [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(08): 805-809.
[11]	Hongyan Tang, Haijun Dan, Zhihong Gao, Zuoyang Zhang, Shumei Zhai, Shaoyu Wu, Yu Zhang. Specificity and sensitivity of cardiac color Doppler ultrasound in clinical diagnosis of patients with chronic heart failure [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(07): 676-679.
[12]	Weiwei Zong, Dongmei Xu, Xinyue Zhang, Jie Geng. Effect of integrated medical and nursing management mode on medication compliance and complications in elderly patients with heart failure treated with sacubitril/valsartan [J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(06): 588-592.
[13]	Yanmei Zhou, Wen Sun, Lin Lin, Juanjuan Chen, Peili Du, Huili Zhang, Jingsi Chen, Lili Du, Dunjin Chen. Diagnosis, treatment and evaluation of preeclampsia complicated with heart failure [J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(04): 228-233.
[14]	Chenglin Zhang, Xuemei Li, Huixin Wu, Xiaoyan Li. Construction of nursing quality evaluation index system of volume management in patients with heart failure [J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 173-178.
[15]	Qianwen Kong, Shan Liu, Caihong Zeng, Qingchun Zeng. Observational study of the effects of aerobic and resistance exercise on heart rate variability in patients with heart failure [J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 160-164.

Please choose a citation manager

Content to export