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Reducing Aortic Barotrauma and Vascular Extracellular Matrix Degradation by Pacemaker-Mediated QRS Widening.
- Source :
-
Journal of the American Heart Association [J Am Heart Assoc] 2020 May 18; Vol. 9 (10), pp. e014804. Date of Electronic Publication: 2020 May 11. - Publication Year :
- 2020
-
Abstract
- Background The extent of pressure-related damage might be related to acceleration rate of the applied pressure (peak dP/dt) in the vascular system. In this study, we sought to determine whether dP/dt applied to the aortic wall (aortic dP/dt) and in turn vascular extracellular matrix degradation can be mitigated via modulation of left ventricular (LV) contractility (LV dP/dt) by pacemaker-mediated desynchronization. Methods and Results First, in 34 patients, changes in aortic dP/dt values in 3 aortic segments in response to pacemaker-mediated stepwise QRS widening leading to gradual desynchronization of the LV contraction by means of steadily changed atrioventricular delay (AVD) with temporary dual-chamber pacing was examined before and after beta-blocker (15 mg IV metoprolol) administration. Second, serum matrix metalloproteinase-9 levels were measured in the 20 patients with permanent pacemaker while they were on sinus rhythm with normal QRS width and 3 weeks after wide QRS rhythm ensured by dual pacing, dual sensing, and dual response to sensing with short AVD. LV dP/dt substantially correlated with dP/dt measured in ascending ( r =0.83), descending ( r =0.89), and abdominal aorta ( r =0.96). QRS width strongly correlated with dP/dt measured in ascending ( r =-0.95), descending ( r =-0.92), and abdominal ( r =-0.96) aortic segments as well. In patients with permanent pacemaker, wide QRS rhythm led to a significant reduction in serum matrix metalloproteinase-9 levels (from 142.5±32.9 pg/mL to 87.5±32.4 pg/mL [ P <0.001]) at the end of 3 weeks follow-up. Conclusions QRS prolongation by short AVD dual pacing, dual sensing, and dual response to sensing results in concomitant decreases in peak dP/dt values in the LV and in all aortic segments with or without background beta-blocker administration, which in turn led to a significant reduction in circulating matrix metalloproteinase-9 levels. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03665558.
- Subjects :
- Adult
Aged
Aorta pathology
Aorta physiopathology
Aortic Diseases metabolism
Aortic Diseases pathology
Aortic Diseases physiopathology
Arrhythmias, Cardiac diagnosis
Arrhythmias, Cardiac physiopathology
Arterial Pressure
Barotrauma metabolism
Barotrauma pathology
Barotrauma physiopathology
Extracellular Matrix pathology
Female
Humans
Male
Matrix Metalloproteinase 9 blood
Mechanotransduction, Cellular
Middle Aged
Pacemaker, Artificial
Prospective Studies
Stress, Mechanical
Treatment Outcome
Vascular Remodeling
Ventricular Function, Left
Ventricular Pressure
Aorta metabolism
Aortic Diseases prevention & control
Arrhythmias, Cardiac therapy
Barotrauma prevention & control
Cardiac Pacing, Artificial
Extracellular Matrix metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 2047-9980
- Volume :
- 9
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American Heart Association
- Publication Type :
- Academic Journal
- Accession number :
- 32390533
- Full Text :
- https://doi.org/10.1161/JAHA.119.014804