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Background: Conduction abnormality post-transcatheter aortic valve implantation (TAVI) remains clinically significant and usually requires chronic pacing. The effect of right ventricular (RV) pacing post-TAVI on clinical outcomes warrants further studies. Methods: We identified 147 consecutive patients who required chronic RV pacing after a successful TAVI procedure and propensity-matched these patients according to the Society of Thoracic Surgeons (STS) risk score to a control group of patients that did not require RV pacing post-TAVI. We evaluated routine echocardiographic measurements and performed offline speckle-tracking strain analysis for the purpose of this study on transthoracic echocardiographic (TTE) images performed at 9 to 18 months post-TAVI. Results: The final study population comprised 294 patients (pacing group n = 147 and non-pacing group n = 147), with a mean age of 81 ± 7 years, 59% male; median follow-up was 354 days. There were more baseline conduction abnormalities in the pacing group compared to the non-pacing group (56.5% vs. 41.5%. p = 0.01). Eighty-eight patients (61.6%) in the pacing group required RV pacing due to atrioventricular (AV) conduction block post-TAVI. The mean RV pacing burden was 44% in the pacing group. Left ventricular ejection fraction (LVEF) was similar at follow-up in the pacing vs. non-pacing groups (57 ± 13.0%, 59 ± 11% p = 0.31); however, LV global longitudinal strain (−12.7 ± 3.5% vs. −18.8 ± 2.7%, p < 0.0001), LV apical strain (−12.9 ± 5.5% vs. 23.2 ± 9.2%, p < 0.0001), and mid-LV strain (−12.7 ± 4.6% vs. −18.7 ± 3.4%, p < 0.0001) were significantly worse in the pacing vs. non-pacing groups. Conclusions: Chronic RV pacing after the TAVI procedure is associated with subclinical LV systolic dysfunction within 1.5 years of follow-up. [ABSTRACT FROM AUTHOR]

Background: Different strategies have been investigated for optimizing atrioventricular (AV) synchrony in patients with dual chamber pacemakers (DDD), which has a crucial role in preserving an effective cardiac output. To utilize the Left ventricular 2D speckle tracking strain parameters as a new tool guiding atrioventricular delay (AVD) synchronization in patients with DDD pacemaker to achieve the best LV systolic performance. Method: This interventional cross-over study involved 255 patients with DDD pacemakers, with mean age 50.62 ± 7.03 years, 175 of them were males 68.6% and 80 were females 31.4%. Each device was programmed to 4 different AV intervals, at one-week interval each; (AV pacing/AV sensing):120/100,150/130,180/160, 200/180 msec). Conventional echocardiographic parameters & left ventricular (LV) 2D speckle tracking (ST) strain were interrogated. Results: At relatively prolonged AVD (180/160 msec), both LV longitudinal strain and left ventricular outflow tract velocity time integral (LVOT VTI) were significantly improved (18.11±1.35 & 27.19 ± 3.16 respectively with P <0.001). Also, E/e showed the lowest values (8.5 ±2.9) and exercise time reached the best between (150/130 and 180/160 msec AVD;309±119 & 320±124, p <0.001 respectively). Conclusions: The benefit of LV speckle tracking based AV optimization looks to result from achieving the best LV systolic performance, this is a very important concern during AV synchronization in DDD pacemakers. [ABSTRACT FROM AUTHOR]

In Anderson–Fabry disease (AFD) the impact of left ventricular (LV) function on cardiac outcome is unknown. Noninvasive LV pressure–strain loop analysis is a new echocardiographic method to estimate myocardial work (MW). We aimed to evaluate whether LV function was associated with outcome and whether MW had a prognostic value in AFD. Ninety-six AFD patients (41.8 ± 14.7 years, 43.7% males) with normal LV ejection fraction were retrospectively evaluated. Inclusion criteria were sinus rhythm and ≥ 2-year follow-up. Standard echocardiography measurements, myocardial mechano-energetic efficiency (MEE) index, global longitudinal strain (GLS) and MW were evaluated. Adverse cardiac events were defined as composite of cardiac death, malignant ventricular tachycardia, atrial fibrillation and severe heart failure development. During a median follow-up of 63 months (interquartile range 37–85), 14 events occurred. Patient age, cardiac biomarkers, LV mass index, left atrium volume, E/Ea ratio, LV ejection fraction, MEE index, GLS and all MW indices were significantly related to adverse outcome at univariate analysis. After adjustment for clinical and echocardiographic parameters, which were significant at univariate analysis, GLS and MW resulted independent predictors of adverse events (p < 0.01). By ROC curve analysis, constructive MW ≤ 1513 mmHg% showed the highest sensitivity and specificity in predicting adverse outcome (92.9% and 86.6%, respectively). MW did not improve the predictive value of a model including clinical data, LV diastolic function and GLS. LV function impairment (both systolic and diastolic) is associated with adverse events in AFD. MW does not provide additive information over clinical features and systolic and diastolic function. [ABSTRACT FROM AUTHOR]