Authors
Konovalov A.S.1, 2, Kalinin R.E.1, Povarov V.O.1, 2, Zhurina O.N.1, Shaburova A.A.1, Suchkov I.A.1
1 Ryazan State Medical University, Ryazan
2 Regional Clinical Cardiology Dispensary, Ryazan
Abstract
Backgraund. Right ventricular apical pacing is believed to induce myocardial remodeling with the development of fibrosis, leading to the progression of heart failure. The interventricular septum has been suggested in some studies as an alternative pacing site; however, convincing evidence of its superiority remains insufficient.
Aims. To evaluate the impact of right ventricular lead localization (right ventricular apex vs. interventricular septum) on the development of heart failure and myocardial fibrosis through a comparative analysis of galectin-3 and NT-proANP dynamics in patients after pacemaker implantation.
Materials and methods. This open-label prospective study enrolled 127 patients with indications for pacemaker implantation. Group 1 (n = 58) received a pacemaker with the ventricular lead positioned at the right ventricular apex. Group 2 (n = 69) received a pacemaker with the lead positioned in the interventricular septum. Laboratory analysis of N-terminal pro-atrial natriuretic peptide (NT-proANP) and galectin-3 was performed before implantation, as well as at 6 and 12 months post-implantation, to assess the severity of heart failure and the extent of myocardial fibrosis.
Results. Key findings included elevated baseline levels of NT-proANP and galectin-3 in both Group 1 [1586.2 (820.7-2694.1) pg/mL and 9.2 (5.9-18.2) ng/mL, respectively] and Group 2 [1848.3 (1111.7-2680.3) pg/mL and 9.9 (5.9-18.2) ng/mL, respectively]. A statistically significant decrease in NT-proANP levels was observed in both groups between the 6- and 12-month follow-up visits (p = 0.015 and p = 0.002) and at 12 months post-implantation (p < 0.001 and p < 0.001). Galectin-3 levels decreased significantly in both groups at 6 months (p = 0.002 and p = 0.004) and 12 months (p < 0.001 and p < 0.001). In Group 2, a statistically significant decrease in galectin-3 was also observed between the 6- and 12-month follow-up visits (p = 0.008); no such difference was found in Group 1 (p = 0.277). Intergroup comparison revealed no statistically significant differences at any of the follow-up time points. ROC analysis revealed a threshold value of NT-proANP of 2448.65 pg/mL as a predictor of one-year mortality (AUC 0.739; p = 0.049), with a sensitivity of 83.3% and a specificity of 68.1%.
Conclusion. The decrease in NT-proANP levels at 12 months in both groups indicates a restoration of ventricular synchrony following a period of bradyarrhythmia. The decrease in galectin-3 after the 6-month follow-up in Group 2 suggests a beneficial effect of septal pacing on the progression of myocardial fibrosis. A high preoperative NT-proANP level serves as a prognostic factor for mortality.
Keywords: pacemaker, artificial, myocardial fibrosis, heart failure, galectin 3, atrial natriuretic factor.
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