ABSTRACT
BACKGROUND: The incidence of worsened clinical outcome due to high right ventricular (RV) pacing burden in patients with preserved left ventricular function remains controversial. OBJECTIVE: To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameters. METHODS: In 60 pacemaker patients with preserved left ventricular ejection fraction (LVEF) serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally, in 48 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation. RESULTS: The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP < 40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12-month pacemaker therapy no changes to left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), LVEF, E/A-ratio; E/E'-ratio and tricuspid annular plane systolic excursion (TAPSE) could be revealed, independently of the RV pacing burden. Additionally, after 24-month long term follow-up there were no differences in LVEF and TAPSE in both groups. Accordingly, no relevant changes of peak exercise capacity, ventilatory anaerobic threshold or maximal oxygen consumption could be demonstrated independently of the RV pacing. CONCLUSIONS: In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence on several echocardiographic and spiroergometric surrogate parameters of pacemaker-induced cardiomyopathy after a follow-up of 12 to 24 month. Despite this, screening for pacemaker induced cardiomyopathy should be performed especially in the presence of new heart failure symptoms.
Subject(s)
Cardiac Pacing, Artificial/methods , Heart Ventricles/physiopathology , Registries , Stroke Volume/physiology , Ventricular Dysfunction, Left/therapy , Ventricular Function, Left/physiology , Aged , Diastole , Echocardiography , Exercise Test , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Humans , Male , Prospective Studies , Retrospective Studies , Time Factors , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Mutualisms with facultative, non-essential heritable microorganisms influence the biology of many insects, and they can have major effects on insect host fitness in certain situations. One of the best-known examples is found in aphids where the facultative endosymbiotic bacterium Hamiltonella defensa confers protection against hymenopterous parasitoids. This symbiont is widely distributed in aphids and related insects, yet its defensive properties have only been tested in two aphid species. In a wild population of the grain aphid, Sitobion avenae, we identified several distinct strains of endosymbiotic bacteria, including Hamiltonella. The symbiont had no consistent effect on grain aphid fecundity, though we did find a significant interaction between aphid genotype by symbiont status. In contrast to findings in other aphid species, Hamiltonella did not reduce aphid susceptibility to two species of parasitoids (Aphidius ervi and Ephedrus plagiator), nor did it affect the fitness of wasps that successfully completed development. Despite this, experienced females of both parasitoid species preferentially oviposited into uninfected hosts when given a choice between genetically identical individuals with or without Hamiltonella. Thus, although Hamiltonella does not always increase resistance to parasitism, it may reduce the risk of parasitism in its aphid hosts by making them less attractive to searching parasitoids.
