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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Predicting Persistent Left Ventricular Dysfunction After Cardiac Resynchronization Therapy Upgrade in Pacing-Induced Cardiomyopathy

  • Jakub Simka1,2
  • Rudolf Praus1,2
  • Jiri Jager1,2
  • Martin Matatko1,2
  • Monika Fialova1,2
  • Eva Cermakova2
  • Jakub Stritecky1,2
  • Ludek Haman1,2
  • Petr Parizek1,2
  1. 1First Department of Internal Medicine Cardiology and Angiology, University Hospital Hradec Kralove, 500 05 Hradec Kralove, Czech Republic
  2. 2Faculty of Medicine in Hradec Kralove, Charles University, 500 03 Hradec Kralove, Czech Republic
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Abstract

Background/Objectives: Pacing-induced cardiomyopathy (PICM) is potentially reversible after cardiac resynchronization therapy (CRT) upgrade, but severe left ventricular dysfunction persists in some patients. We evaluated predictors of persistent left ventricular ejection fraction (LVEF) ≤ 35% after CRT upgrade and long-term outcomes. Methods: We analysed 60 patients undergoing CRT upgrade for PICM. The primary outcome was persistent LVEF ≤ 35% at 12 months. Clinical, electrocardiographic, echocardiographic, and long-term outcomes were assessed. Results: At 12 months, median LVEF increased from 30% to 45% (p < 0.01), and 82% of patients recovered to an LVEF > 35%. Persistent severe left ventricular dysfunction was associated with lower baseline LVEF (22% vs. 30%; p < 0.01), greater left ventricular end-diastolic diameter (LVEDD) (65 mm vs. 58 mm; p = 0.03), and longer post-CRT QRS duration (154 ms vs. 140 ms; p = 0.02); none remained independently significant after multivariable adjustment. No patient with baseline LVEF > 25% and LVEDD < 65 mm had persistent severe LV dysfunction, compared with 46% of those with LVEF ≤ 25% and LVEDD ≥ 65 mm. In the 12-month landmark analysis, mortality through 60 months after CRT upgrade was 55% in patients with persistent severe LV dysfunction and 31% in those with LVEF recovery. Conclusions: CRT upgrade was associated with substantial recovery of LV systolic function in patients with PICM. Severe baseline LV dysfunction and LV dilatation were associated with a lower likelihood of recovery to an LVEF > 35%. These exploratory findings may aid risk stratification but require prospective validation.

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Cite

BibTeXRIS
BibTeX
@article{simka2026predicting,
  title = {{Predicting Persistent Left Ventricular Dysfunction After Cardiac Resynchronization Therapy Upgrade in Pacing-Induced Cardiomyopathy}},
  author = {Jakub Simka and Rudolf Praus and Jiri Jager and Martin Matatko and Monika Fialova and Eva Cermakova and Jakub Stritecky and Ludek Haman and Petr Parizek},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218731},
  url = {https://www.mdpi.com/2077-0383/15/21/8731},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Predicting Persistent Left Ventricular Dysfunction After Cardiac Resynchronization Therapy Upgrade in Pacing-Induced Cardiomyopathy
AU  - Jakub Simka
AU  - Rudolf Praus
AU  - Jiri Jager
AU  - Martin Matatko
AU  - Monika Fialova
AU  - Eva Cermakova
AU  - Jakub Stritecky
AU  - Ludek Haman
AU  - Petr Parizek
PY  - 2026
DA  - 2026/11/09
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218731
UR  - https://www.mdpi.com/2077-0383/15/21/8731
AB  - Background/Objectives: Pacing-induced cardiomyopathy (PICM) is potentially reversible after cardiac resynchronization therapy (CRT) upgrade, but severe left ventricular dysfunction persists in some patients. We evaluated predictors of persistent left ventricular ejection fraction (LVEF) ≤ 35% after CRT upgrade and long-term outcomes. Methods: We analysed 60 patients undergoing CRT upgrade for PICM. The primary outcome was persistent LVEF ≤ 35% at 12 months. Clinical, electrocardiographic, echocardiographic, and long-term outcomes were assessed. Results: At 12 months, median LVEF increased from 30% to 45% (p < 0.01), and 82% of patients recovered to an LVEF > 35%. Persistent severe left ventricular dysfunction was associated with lower baseline LVEF (22% vs. 30%; p < 0.01), greater left ventricular end-diastolic diameter (LVEDD) (65 mm vs. 58 mm; p = 0.03), and longer post-CRT QRS duration (154 ms vs. 140 ms; p = 0.02); none remained independently significant after multivariable adjustment. No patient with baseline LVEF > 25% and LVEDD < 65 mm had persistent severe LV dysfunction, compared with 46% of those with LVEF ≤ 25% and LVEDD ≥ 65 mm. In the 12-month landmark analysis, mortality through 60 months after CRT upgrade was 55% in patients with persistent severe LV dysfunction and 31% in those with LVEF recovery. Conclusions: CRT upgrade was associated with substantial recovery of LV systolic function in patients with PICM. Severe baseline LV dysfunction and LV dilatation were associated with a lower likelihood of recovery to an LVEF > 35%. These exploratory findings may aid risk stratification but require prospective validation.
SN  - 2077-0383
ER  -