Heart stress and heart failure with preserved ejection fraction in patients with conduction disorders undergoing permanent pacemaker implantation
Abstract
Background: Conduction disturbances and heart failure (HF) share overlapping risk factors, yet the prevalence of HF with preserved (HFpEF) and mildly reduced ejection fraction (HFmrEF) and heart stress in patients undergoing antibradycardia pacemaker implantation remains underexplored. Objectives: The aim was to assess the prevalence of HFpEF, HFmrEF and heart stress in patients undergoing de novo antibradycardia pacemaker implantation, and to evaluate associated structural and functional cardiac abnormalities. Methods: This prospective single-center registry included 128 patients undergoing permanent pacemaker implantation between November 2022 and May 2025. All patients underwent thorough pre-implantation evaluation, including comprehensive echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement. HF and heart stress were defined according to European Society of Cardiology and Heart Failure Association guidelines. Results: Among patients (age range: 27–94 years; 59% male; 41% with atrial fibrillation), 20% met diagnostic criteria for HF (HfpEF/HFmrEF), while 59% had heart stress. Only 8% of patients with HF had a prior HF diagnosis. Patients with HF (HFpEF/HFmrEF) had a higher prevalence of atrial fibrillation, coronary artery disease, and echocardiographic indices of left ventricular (LV) diastolic dysfunction and cardiac remodeling, including LV hypertrophy (46%), left atrial enlargement (85%) and pulmonary hypertension (42%). Patients with concentric LV hypertrophy had significantly higher NT-proBNP levels than those with other LV geometric patterns. Conclusions: HFpEF and heart stress are common but frequently underdiagnosed in patients undergoing pacemaker implantation. Systematic screening may facilitate earlier identification and initiation of guideline-directed therapy, which warrants further investigation in prospective studies assessing its impact on clinical outcomes in this high-risk population.