Author + information
- Received September 3, 2018
- Revision received November 20, 2018
- Accepted December 1, 2018
- Published online April 29, 2019.
- Li Shen, MBChB, PhDa,
- Pardeep S. Jhund, MBChB, PhDa,
- Kieran F. Docherty, MBChBa,
- Mark C. Petrie, MBChBa,
- Inder S. Anand, MD, DPhilb,
- Peter E. Carson, MDc,
- Akshay S. Desai, MD, MPHd,
- Christopher B. Granger, MDe,
- Michel Komajda, MDf,
- Robert S. McKelvie, MD, PhDg,
- Marc A. Pfeffer, MD, PhDd,
- Scott D. Solomon, MDd,
- Karl Swedberg, MD, PhDh,i,
- Michael R. Zile, MDj,k and
- John J.V. McMurray, MDa,∗ ()
- aBritish Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom
- bDepartment of Medicine, University of Minnesota Medical School, and Veterans Affairs Medical Center, Minneapolis, Minnesota
- cCardiovascular Division, Department of Cardiology, Washington Veterans Affairs Medical Center, Washington, DC
- dCardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- eDivision of Cardiovascular Medicine, Department of Internal Medicine, Duke Clinical Research Institute, Duke University, Durham, North Carolina
- fDepartment of Cardiology, Hospital Saint Joseph, Paris, France
- gDepartment of Medicine, Western University, London, Ontario, Canada
- hDepartment of Molecular and Clinical Medicine, University of Gothenburg, Sweden
- iNational Heart and Lung Institute, Imperial College, London, United Kingdom
- jMedical University of South Carolina, Charleston, South Carolina
- kRalph H. Johnson Veterans Administration Medical Center, Charleston, South Carolina
- ↵∗Address for correspondence:
Prof. John J.V. McMurray, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, United Kingdom.
Objectives This study examined the relationship between prior pacemaker implantation and clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).
Background Conventional right ventricular pacing causes electrical and mechanical left ventricular dyssynchrony and may worsen left ventricular systolic dysfunction and HF. Whether conventional pacing is also associated with worse outcomes in HFpEF is unknown.
Methods Patient data were pooled from the CHARM-Preserved (Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity), I-PRESERVE (Irbesartan in Heart Failure with Preserved Ejection Fraction), and TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial) studies and were examined for the association between having a pacemaker and the risk of the primary composite of cardiovascular death or HF hospitalization, the individual components of the composite, the 2 main modes of cardiovascular death (i.e., sudden death and pump failure death), and all-cause death in unadjusted and adjusted analyses.
Results Of the 8,466 patients included, 682 patients (8%) had a pacemaker. Pacemaker patients were older and more often men and had lower body mass indexes, estimated glomerular filtration rates, and blood pressures but higher concentrations of N-terminal pro–B-type natriuretic peptide than those without a pacemaker. The rate of the primary composite outcome in pacemaker patients was almost twice that in patients without a pacemaker (13.6 vs. 7.6 per 100 patient-years of follow up, respectively), with a similar finding for HF hospitalizations (10.8 vs. 5.1 per 100 patient-years, respectively). This risk rate persisted after adjusting for other prognostic variables (hazard ratio [HR] for the composite outcome: 1.17; 95% confidence interval [CI]: 1.02 to 1.33; p = 0.026), driven mainly by HF hospitalization (HR: 1.37; 95% CI: 1.17 to 1.60; p < 0.001). The risk of death was not significantly higher in pacemaker patients in the adjusted analyses.
Conclusions These findings raise the possibility that right ventricular pacing-induced left ventricular dyssynchrony may be detrimental in HFpEF patients.
Dr. Desai has received research grants from and consults for Novartis; and is a consultant for Abbott, AstraZeneca, Relypsa, Regeneron, DalCor Pharma, Boehringer Ingelheim, Boston Scientific, Signature Medical, and Corvidia. Dr. Granger has received research grants and speaker fees from and is a consultant for Abbvie, Apple, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol-Myers Squibb, U.S. Food and Drug Administration, Gilead Science, GlaxoSmithKline, Janssen, Medscape, Medtronic, Medtronic Foundation, Merck Sharpe & Dohme, U.S. National Institutes of Health, Novo Nordisk, Novartis, Pfizer, Roche Diagnostics, Rho Pharmaceuticals, Sirtex, and Verseon. Dr. Komajda is a consultant for Servier and Sanofi; has received speaker fees from Servier, Novartis, Sanofi, and Merck Sharpe & Dohme; and has received speaker fees from and is a consultant for Novartis, Merck Sharpe & Dohme, Bristol-Myers Squibb, Sanofi, and Novo Nordisk. Dr. Pfeffer has received research grant support from Novartis; is a consultant for AstraZeneca, DalCor, GlaxoSmithKline, Novartis, Novo Nordisk, Pfizer, Roche, Sanofi, and Servier; and holds stock options in DalCor. Dr. Solomon has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bristol-MyersSquibb, Celladon, Cytokinetics, Eidos, Gilead, GlaxoSmithKline, Ionis, Lone Star Heart, Mesoblast, MyoKardia, U.S. National Institutes of Health/National Heart, Lung, and Blood Institute, Novartis, Sanofi Pasteur, and Theracos; and is a consultant for Akros, Alnylam, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Cardior, Corvia, Cytokinetics, Gilead, GlaxoSmithKline, Ironwood, Merck Sharpe & Dohme, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, and Cardiac Dimensions. Dr. Swedberg is an advisory board member of AstraZeneca, Novartis, Pfizer, and Servier; and has received honoraria from Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 3, 2018.
- Revision received November 20, 2018.
- Accepted December 1, 2018.
- 2019 American College of Cardiology Foundation
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