Effects of Continuous Accelerated Pacing on Cardiac Structure and Function in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the myPACE Randomized Clinical Trial

Figures

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  Figure 1. Identification of transthoracic echocardiograms for study inclusion. RCT indicates randomized controlled trial.

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  Figure 2. Temporal relationship of the myPACE randomized clinical trial and the before and after trial echocardiograms included in this study. RCT indicates randomized controlled trial; and bpm, beats per minute.

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  Figure 3. Alluvial diagram representing change in the range of left ventricular ejection fraction between echocardiograms obtained before myPACE clinical trial enrollment and after trial enrollment while exposed to the pacing intervention. RCT indicates randomized controlled trial; and LV, left ventricle.

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  Figure 4. Relationship between the temporal change in left ventricular ejection fraction and the change in heart failure‐related quality of life during the myPACE clinical trial. There was no significant correlation between the changes in ejection fraction and Minnesota Living with Heart Failure Questionnaire in either group (Spearman rho=0.16; P=0.35). MLHFQ indicates Minnesota Living with Heart Failure Questionnaire; and EF, (left ventricular) ejection fraction.

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  Figure 5. Schematic illustration of putative mechanisms that convey the clinical benefits of therapeutic heart rate modulation. The immediate hemodynamic benefits are followed by favorable LV remodeling with a reduction in wall thickness and improved capacitance that would be expected to improve LV compliance and reserve capacity. This process is accompanied by a modest reduction in ejection fraction. HFpEF indicates heart failure with preserved ejection fraction; and LV, left ventricular.