Effect of paced heart rate on quality of life and natriuretic peptides for stage B or C heart failure with preserved ejection fraction: A secondary analysis of the myPACE trial.
Por:
de la Espriella R, Wahlberg K, Infeld M, Palau P, Nunez E, Sanchis J, Meyer M, Nunez J
Publicada:
2 ene 2024
Ahead of Print:
2 ene 2024
Resumen:
AIM: Emerging evidence suggests a beneficial effect of higher heart rates in some patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to evaluate the impact of higher backup pacing rates in HFpEF patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony across left ventricular (LV) volumes and LV ejection fraction (LVEF). METHODS AND RESULTS: This is a post-hoc analysis of the myPACE clinical trial that evaluated the effects of personalized accelerated pacing setting (myPACE) versus standard of care on changes in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), pacemaker-detected activity levels, and atrial fibrillation (AF) burden in patients with HFpEF with preexisting pacemakers. Between-treatment comparisons were performed using linear regression models adjusting for the baseline value of the exposure (ANCOVA design). This study included 93 patients with pre-trial transthoracic echocardiograms available (usual care n = 49; myPACE n = 44). NT-proBNP levels and MLHFQ scores improved in a higher magnitude in the myPACE group at lower indexed LV end-diastolic volumes (iLVEDV) (NT-proBNP-iLVEDV interaction p = 0.006; MLHFQ-iLVEDV interaction p = 0.068). In addition, personalized accelerated pacing led to improved changes in activity levels and NT-proBNP, especially at higher LVEF (activity levels-LVEF interaction p = 0.009; NT-proBNP-LVEF interaction p = 0.058). No evidence of heterogeneity was found across LV volumes or LVEF for pacemaker-detected AF burden. CONCLUSIONS: In the post-hoc analysis of the myPACE trial, we observed that the benefits of a personalized accelerated backup pacing on MLHFQ score, NT-proBNP, and pacemaker-detected activity levels appear to be more pronounced in patients with smaller iLVEDV and higher LVEF.
Filiaciones:
de la Espriella R:
Department of Cardiology. Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain
Wahlberg K:
University of Vermont, Larner College of Medicine, Department of Medicine, Burlington, VT, 05401
Infeld M:
Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
Palau P:
Department of Cardiology. Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain
Department of Medicine, Universitat de Valencia. Valencia, Spain
Nunez E:
Department of Cardiology. Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain
Sanchis J:
Department of Cardiology. Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain
Department of Medicine, Universitat de Valencia. Valencia, Spain
Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
Meyer M:
Lillehei Heart Institute, Department of Medicine, University of Minnesota College of Medicine, Minneapolis
Nunez J:
Department of Cardiology. Hospital Clinico Universitario de Valencia (INCLIVA), Valencia, Spain
Department of Medicine, Universitat de Valencia. Valencia, Spain
Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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