ABSTRACT
Background
The causes of heart failure (HF) during high-grade atrioventricular block (AVB) are
poorly understood. This study assessed the mechanisms of HF in patients with AVB.
Methods
We studied patients presenting (between 2012 and 2016) with high-grade AVB not related
to acute myocardial infarction. Patients with preexisting significant valvular heart
disease were excluded. All patients underwent comprehensive echocardiographic evaluation
during AVB, before pacemaker implantation. The diagnosis of HF was based on the Framingham
criteria.
Results
A total of 122 patients were included in the study, 50% male, average age 76 ± 13
years. Twenty-eight patients (23%) with AVB presented with HF. Univariate correlates
associated with HF were decrease in cardiac output (CO) (odds ratio [OR] 0.68 [95%
confidence interval 0.49-0.9] per L/min; P = 0.007), measures of impaired left ventricular (LV) compliance, and increase in
diastolic mitral regurgitation (MR) volume (OR 1.04 [1.01-1.07] per cc; P = 0.0016). Ventricular rate during AVB and LV ejection fraction were not significantly associated
with the presence of HF. By multivariate nominal logistic analysis, the best model
associated with HF included diastolic MR volume (OR 1.04 [1.001-1.09]; P = 0.02), A-wave deceleration time (OR 0.96 [0.94-0.9]; P = 0.001), and CO (OR 0.92 [0.4-1.00]; P = 0.005) (χ2 = 30.6; area under the receiver operating characteristic curve = 0.84; P < 0.0001 for the entire model).
Conclusions
In the setting of high-degree AVB, clinical HF occurrence correlates with impaired
LV compliance and diastolic MR volume, but not with heart rate or LV ejection fraction.
The cardiac performance of patients with poor LV compliance and high-volume diastolic
MR may show maladjustment to slow heart rates, manifesting as low CO and HF.
Résumé
Contexte
Les causes de l'insuffisance cardiaque (IC) lors d'un bloc auriculo-ventriculaire
(BAV) de haut grade sont mal comprises. Cette étude a évalué les mécanismes de l'IC
chez les patients atteints de BAV.
Méthodes
Nous avons étudié des patients présentant (entre 2012 et 2016) un BAV de haut grade
non lié à un infarctus aigu du myocarde. Les patients présentant une cardiopathie
valvulaire significative préexistante ont été exclus. Tous les patients ont subi une
évaluation échocardiographique complète pendant le BAV, avant l'implantation d'un
stimulateur cardiaque. Le diagnostic d'IC était basé sur les critères de Framingham.
Résultats
Un total de 122 patients ont été inclus dans l'étude, 50 % d'hommes, âge moyen 76
± 13 ans. Vingt-huit patients (23 %) atteints de BAV présentaient une IC. Les corrélats
univariés associés à l'IC étaient la diminution du débit cardiaque (DC) (rapport de
cotes [RC] 0,68 l/min [intervalle de confiance à 95 % 0,49-0,9]; P = 0,007), les mesures de la compliance du ventricule gauche (VG) altérée, et l'augmentation
du volume de régurgitation mitrale (RM) diastolique (RC 1,04 par cc [1,01-1,07]; P = 0,0016). La fréquence ventriculaire pendant le BAV et la fraction d'éjection du
ventricule gauche n'étaient pas significativement associées à la présence d'une IC.
Par analyse logistique nominale multivariée, le modèle optimal associé à l'IC comprenait
le volume diastolique de la RM (RC 1,04 [1,001-1,09]; P = 0,02), le temps de décélération de l'onde A (RC 0,96 [0,94-0,9]; P = 0,001) et le DC (RC 0,92 [0,4-1,00]; P = 0,005) (χ2 = 30,6; aire sous la courbe de la fonction d'efficacité du récepteur = 0,84;
P < 0,0001 pour le modèle complet).
Conclusions
Dans le cadre d'un BAV de haut degré, la survenue d'une IC clinique est corrélée à
une compliance du VG et un volume RM diastolique altérés, mais pas à la fréquence
cardiaque ou à la fraction d'éjection VG. La performance cardiaque des patients présentant
une faible compliance du VG et un volume élevé de RM diastolique peut présenter une
inadaptation aux fréquences cardiaques lentes, se manifestant par un faible DC et
une IC.
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Article info
Publication history
Published online: May 20, 2021
Accepted:
May 16,
2021
Received:
December 15,
2020
Footnotes
See page 1568 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
