Right Ventricular Dysfunction
Conditions
Keywords
right ventricular dysfunction, right ventricular function, Cardiac Implantable Electronic Device, Implantable Cardioverter-Defibrillator, pacemaker, Cardiac Resynchronisation Therapy, Cardiac Magnetic Resonance Imaging, Echocardiography, VExUS, Venous Congestion, Fibroblast Growth Factor 23, Brain Natriuretic Peptide
Brief summary
This study aims to understand how the right side of the heart changes in people who receive an implantable cardiac electronic device (CIED), such as a pacemaker, ICD, or CRT device. The right ventricle (RV) can sometimes be affected after these devices are placed, but the reasons and timing are not well understood. To investigate this, we will examine participants at two time-points: before their device is implanted and again six months later. At each visit, we will assess heart function using echocardiography, a non-contrast cardiac MRI scan, and an ultrasound score of venous congestion called the VEXUS score. We will also take a small blood sample to measure a biomarker called FGF-23, which may reflect changes in heart function. The study does not involve any experimental treatment, and all implanted devices are part of routine medical care. The imaging tests and blood samples are for research purposes only. By comparing the measurements before and after device implantation, we hope to better understand how CIEDs influence right-sided heart function and whether imaging findings are related to changes in blood biomarkers.
Detailed description
Right ventricular (RV) dysfunction and tricuspid valve changes are increasingly recognised in patients who receive implantable cardiac electronic devices (CIEDs). Potential mechanisms include lead-leaflet interaction, pacing-related alterations in RV mechanics and changes in venous haemodynamics. However, prospective data integrating advanced imaging, ultrasound-based congestion assessment and circulating biomarkers remain limited. This prospective observational cohort study will evaluate RV structure and function at two predefined time-points: immediately before CIED implantation and at six months after implantation. Assessments will include (1) transthoracic echocardiography with quantitative RV parameters, (2) a standardised VEXUS ultrasound score for systemic venous congestion, (3) non-contrast cardiac magnetic resonance (CMR) imaging for RV volumetry and tissue characterisation and (4) plasma measurement of FGF-23 as a biomarker potentially associated with RV remodelling. All implanted devices are clinically indicated and form part of routine care; no experimental device or therapeutic intervention is used. Imaging and blood sampling performed for the study are non-interventional and carry minimal risk. The purpose of the study is to quantify changes in RV size and function over six months and to explore whether alterations in imaging findings correspond to changes in venous congestion or biomarker levels. The results may help identify patients at risk of adverse RV remodelling following CIED implantation.
Interventions
OTHERMultimodal Right Ventricular Evaluation
Non-invasive assessments including transthoracic echocardiography, VEXUS ultrasound scoring, non-contrast cardiac MRI using 1.5T scanner, and venous blood sampling for EDTA plasma biomarker analysis (FGF-23 and BNP). These procedures are for research measurements only and do not alter or replace routine clinical care. No therapeutic intervention or assignment is performed.
Sponsors
Istanbul University - Cerrahpasa
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults aged 18 years or older. * Scheduled to undergo implantation of a clinically indicated pacemaker, ICD, or CRT device. * Able to undergo transthoracic echocardiography, VEXUS ultrasound assessment, and non-contrast cardiac MRI. * Able to provide written informed consent.
Exclusion criteria
* Contraindication to cardiac MRI (e.g., severe claustrophobia or MRI-unsafe implanted material). * Inability to undergo echocardiography or ultrasound assessment. * Known pulmonary arterial hypertension (Group 1 PH). * Significant congenital heart disease. * Patients with mechanical or bioprosthetic heart valve replacement * Severe left-sided valvular disease (severe AS or severe MR). * Chronic kidney disease stage 4 or 5 (eGFR \< 30 mL/min/1.73m²). * End-stage renal disease requiring dialysis. * Primary hyperparathyroidism. * Hypophosphataemia or hyperphosphataemia requiring treatment. * Active or uncontrolled bone metabolism disorders (e.g., osteomalacia, Paget's disease). * Recent fracture or major orthopaedic surgery within the past 3 months. * Active systemic inflammatory or autoimmune disease. * Active malignancy or malignancy requiring ongoing treatment. * Active infection at the time of enrolment. * Pregnancy or breastfeeding. * Haemodynamic instability at the time of enrolment. * Expected survival less than 6 months due to non-cardiac conditions. * Inability to provide informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Right Ventricular Ejection Fraction (RVEF) by Cardiac MRI | Baseline (pre-implantation) to 6 months post-implantation | RVEF will be quantified using non-contrast 1.5T cardiac MRI cine imaging. The primary endpoint is the absolute change in RVEF between pre-implantation and 6-month follow-up. |
| Change in Tricuspid Regurgitation Severity | Baseline to 6 months | Tricuspid regurgitation will be graded (none, mild, moderate, severe) using echocardiography and confirmed by CMR-derived regurgitant volume. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Right Ventricular Longitudinal Strain (RV-FWLS) | Baseline to 6 months | Measured via speckle-tracking echocardiography. |
| Change in Plasma FGF-23 Concentration | Baseline to 6 months | EDTA plasma FGF-23 will be measured via ELISA. The endpoint is the change in concentration from baseline to 6 months. |
| Change in Right Ventricular End-Diastolic Volume (RVEDV) by Cardiac MRI | Baseline to 6 months | RVEDV will be measured from short-axis cine stacks. The endpoint is the change in volume between baseline and 6 months. |
| Lead-related Tricuspid Valve Interaction | 6 months | Based on CMR evaluation of lead-leaflet relationship (septal, posteroseptal, anterior leaflet proximity or impingement). |
| Change in BNP Concentration | Baseline to 6 months | Plasma BNP levels will be measured as a secondary biochemical marker. |
| Change in VEXUS Score | Baseline to 6 months | VEXUS venous congestion score (IVC, hepatic vein Doppler, portal vein pulsatility, renal vein Doppler) will be calculated at each visit. |
Countries
Turkey (Türkiye)
Contacts
Primary ContactSAHRA ASENA BALCIOGLU, MD
Outcome results
None listed