Personalized accelerated backup pacing improved NT-proBNP more in HFpEF patients with smaller indexed LV end-diastolic volumes (interaction p=0.006) and higher LVEF (interaction p=0.058).
RCT (n=93)
Does personalized accelerated pacing improve quality of life and natriuretic peptides in patients with HFpEF and preexisting pacemakers?
Personalized accelerated backup pacing in HFpEF patients with pacemakers may offer greater benefits in quality of life and NT-proBNP reduction among those with smaller LV volumes and higher LVEF.
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.
Espriella et al. (Thu,) conducted a rct in Heart failure with preserved ejection fraction (HFpEF) (n=93). Personalized accelerated pacing setting (myPACE) vs. Standard of care was evaluated 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. Personalized accelerated backup pacing improved NT-proBNP more in HFpEF patients with smaller indexed LV end-diastolic volumes (interaction p=0.006) and higher LVEF (interaction p=0.058).