title: One-Month Global Longitudinal Strain Identifies Patients Who Will Develop Pacing-Induced Left Ventricular Dysfunction over Time: The Pacing and Ventricular Dysfunction (PAVD) Study.
abstract: Predicting which individuals will have a decline in left ventricular (LV) function after pacemaker implantation remains an important challenge. We investigated whether LV global longitudinal strain (GLS), measured by 2D speckle tracking strain echocardiography, can identify patients at risk of pacing-induced left ventricular dysfunction (PIVD) or pacing-induced cardiomyopathy (PICMP).
  
  
  
  Fifty-five patients with atrioventricular block and preserved LV function underwent dual-chamber pacemaker implantation and were followed with serial transthoracic echocardiography for 12 months for the development of PIVD (defined as a reduction in LV ejection fraction (LVEF) ≥5 percentage points at 12 months) or PICMP (reduction in LVEF to <45%).
  
  
  
  At 12 months, 15 (27%) patients developed PIVD; of these, 4 patients developed PICMP. At one month, GLS was significantly lower in the 15 patients who subsequently developed PIVD, compared to those who did not (n = 40) (GLS -12.6 vs. -16.4 respectively; p = 0.022). When patients with PICMP were excluded, one month GLS was significantly reduced compared to baseline whereas LVEF was not. One-month GLS had high predictive accuracy for determining subsequent development of PIVD or PICMP (AUC = 0.80, optimal GLS threshold: <-14.5, sensitivity 82%, specificity 75%); and particularly PICMP (AUC = 0.86, optimal GLS threshold: <-13.5, sensitivity 100%, specificity 71%).
  
  
  
  GLS is a novel predictor of decline in LV systolic function following pacemaker implantation, with the potential to identify patients at risk of PIVD before measurable changes in LVEF are apparent. GLS measured one month after implantation has high predictive accuracy for identifying patients who later develop PIVD or PICMP.
authors.affiliation: Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.|Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Fozia Zahir
authors.initials: FZ
authors.lastname: Ahmed
authors.affiliation: Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.affiliation: Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Cunnington
authors.affiliation: Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care, University of Keele, Keele, United Kingdom.|University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
authors.forename: Chun Shing
authors.initials: CS
authors.lastname: Kwok
authors.affiliation: Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.|Department of Biostatistics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Fullwood
authors.affiliation: Cardiovascular Institute, Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.
authors.forename: Delvac
authors.initials: D
authors.lastname: Oceandy
authors.affiliation: Department of Cardiology, Lancashire Cardiac Centre, Blackpool, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Fitchet
authors.affiliation: Department of Cardiology, Salford Royal Foundation Trust, Stott Lane, Salford, United Kingdom.
authors.forename: Grahame Kevin
authors.initials: GK
authors.lastname: Goode
authors.affiliation: Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Luckie
authors.affiliation: Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Manchester, United Kingdom.
authors.forename: Amir Masood
authors.initials: AM
authors.lastname: Zaidi
authors.affiliation: Department of Cardiology, Royal Brompton Hospital and Cardiovascular Biomedical Research Unit, Imperial College, London, United Kingdom.
authors.forename: Rajdeep
authors.initials: R
authors.lastname: Khattar
authors.affiliation: Cardiovascular Research Group, Institutes of Science and Technology in Medicine and Primary Care, University of Keele, Keele, United Kingdom.|University Hospital North Midlands, Stoke-on-Trent, United Kingdom.
authors.forename: Mamas Andreas
authors.initials: MA
authors.lastname: Mamas
mesh_terms: D000368:Aged; D054537:Atrioventricular Block / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013312:Stress, Physiological; D013318:Stroke Volume; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology