Relationship between CTGF levels and echocardiographic parameters in patients after permanent pacemaker implantation

Abstract

Introduction: In recent decades, the dual-chamber pacemaker has become the gold standard for treating high-degree atrioventricular block. Despite the incredible benefits of overcoming conduction disorders, undeniable evidence has accumulated in recent years of negative effects of permanent right ventricular apical stimulation. The aim of our study was to examine the cytokines responsible for activation of the fibrotic process in patients after PPM implantation with apical right ventricular stimulation. Material and Methods: CTGF levels were investigated by enzyme-linked immunoassays in plasma from 45 patients (25 men, 20 women, aged 72.1±9 years) and 46 controls (24 men, 22 women, aged 71.9±8.7 years) without known cardiovascular diseases (except arterial hypertension, conduction disorder, indication for the procedure) at baseline (for patients immediately before PPM implantation), at 12 and 24 weeks. At the same visits echocardiography was performed. Results: There was no difference in baseline CTGF levels between patients and controls (312.66±15.25 vs 313.05±12.98 p>0.05). In patients, at week 12, CTGF levels were significantly increased compared to baseline in controls (627.74±41.81 vs 313.05±12.98 pg/ml p<0.001). At week 24, values continued to increase, being again significantly higher than baseline in controls (400.83±13.29 vs 313.05±12.98 pg/ml p<0.001). Conclusion: Our data analysis gives us reason to conclude that there is a significant increase in the levels of the growth factor after PPM implantation and it plays a major role in fibrotic remodeling of the myocardium. We guess increase in filling pressure of the left ventricle that is followed by LA pressure load and is a prerequisite for its dilatation.