Midrange ejection fraction as a risk factor for deterioration of cardiofunction after permanent pacemaker implantation

  • Hua HeEmail author
  • XiaoDong Li
  • BingBing Ke
  • Zhuo Chen
  • FuSheng Han
  • YuJie ZengEmail author



To determine whether the midrange ejection fraction (mrEF) is associated with increased risk of deterioration of cardiac function (DCF) after dual chamber permanent pacemaker (PPM) implantation.


We performed a prospective cohort study of relevance in patients with EF ≥ 40% and indications for PPMs. Patient characteristics were recorded at baseline and 1 day, 1 month, 3 months, and 6 months after PPM implantation with leads placed in the right ventricular apex. These included clinical symptoms, signs, biochemical parameters, BNP, echocardiography and ECG parameters, and pacing-related parameter changes. The patients were followed-up for 6 months. Univariate and multivariable Cox regression analyses were performed.


A total of 879 patients were included, aged 35 to 88 years (mean age 67.2 ± 9.6); a total of 81 patients (9.2%) developed DCF after PPM implantation, including LVEF < 40% (57 cases) and increased NYHA class (24 cases). Cox models demonstrated that age ≥ 75 years (HR 2.273 [95% CI, 1.541–3.626]), OMI (HR 2.078 [95% CI, 1.275–3.604]), mrEF (HR 2.762 [95% CI, 1.558–4.769]), moderate mitral regurgitation (HR 2.819 [95% CI, 1.604–4.153]), and right ventricular pacing ≥ 50% (HR 2.311 [95% CI, 1.478–3.937]) were strong predictors for DCF, and NT-proBNP > 1000 ng/L and paced QRS duration ≥ 180 ms were also the independent predictors of DCF.


MrEF was associated with increased risk of deterioration of cardiac function after PPM implantation. Moderate mitral regurgitation and increased NT-proBNP levels are also potential independent predictors for deterioration of cardiac function after PPM implantation.


Permanent pacemaker implantation Heart failure Midrange ejection fraction B-type natriuretic peptide 


Funding information

This study was funded by the Cultivating Project Grants of Beijing for Highly Talented Men of Medicine (2014-3-042) and the Basic Clinical Research Program of Capital Medical University (17JL15).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was reviewed and approved by the Institutional Ethics Committee of the Anzhen Hospital and Beijing Institute of Heart Lung and Blood Vessel Diseases.

Supplementary material

10840_2019_513_MOESM1_ESM.doc (82 kb)
ESM 1 (DOC 82 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Emergency Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  2. 2.Department of Echocardiography, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel DiseasesCapital Medical UniversityBeijingChina

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