The Physiological Role of BNP and Galectin-3 in Predicting Pacing Dependency in Patients with Cardiovascular Implantable Electronic Devices

Khalid Saud Salih

doi:10.54133/ajms.v9i2.2542

Authors

Khalid Saud Salih Department of Pharmacology and Toxicology, College of Pharmacy, Tikrit University, Tikrit 34001, Iraq https://orcid.org/0000-0003-3459-8170

DOI:

https://doi.org/10.54133/ajms.v9i2.2542

Keywords:

BNP, Chronic kidney disease, Galactin-3, Pacemaker dependency

Abstract

Background: Pacemaker dependency is a critical consideration in patients with cardiovascular implantable electronic devices (CIEDs). Objective: To evaluate the predictive value of B-type natriuretic peptide (BNP) and galectin-3 in forecasting pacing dependency in patients with CIED. Methods: One hundred patients with CIEDs were classified as pacing dependent (n=39) or non-dependent (n=61) based on established criteria. Associations with clinical and biomarker variables were analyzed using univariate and multivariate logistic regression. Receiver operating characteristic (ROC) curves assessed the predictive value of BNP and galectin-3. Results: Pacing dependency was significantly associated with longer CIED duration (≥5 years), chronic kidney disease, and second- or third-degree atrioventricular block. Patients with severe left ventricular dysfunction were more likely to be pacing dependent. Median BNP and galectin-3 levels were significantly higher in the pacing-dependent group (269pg/ml and 22ng/ml, respectively). Multivariate analysis identified CIED duration >5 years (OR=3.28), CKD (OR=3.47), NYHA class III (OR=3.88), NYHA class IV (OR=5.33), BNP >160pg/ml (OR=6.23), and galectin-3 >16ng/ml (OR=2.12) as independent predictors of pacing dependency. The ROC analysis showed that BNP (AUC=0.836) and galectin-3 (AUC=0.715) were good predictors, and they were even better when used together (AUC=0.912, sensitivity=87%, specificity=85%). Conclusions: BNP and galectin-3 are valuable biomarkers for predicting pacing dependency in patients with CIEDs, and they provide a robust model for identifying patients at higher risk of pacing dependency when combined with clinical parameters.

Downloads

Download data is not yet available.

References

Grimm W, Grimm K, Greene B, Parahuleva M. Predictors of pacing-dependency in patients with cardiovascular implantable electronic devices. Cardiol J. 2021;28(3):423-430. doi: 10.5603/CJ.a2019.0088. DOI: https://doi.org/10.5603/CJ.a2019.0088

Abdullah HA, Al-Mossawi A, Al-Iqabby KAI. Prevalence and predictors of pacemaker dependency: Data from a cardiac centre registry in Iraq. Cor et Vasa. 2023;65(5):735-739. doi: 10.33678/cor.2023.022. DOI: https://doi.org/10.33678/cor.2023.022

Lelakowski J, Majewski J, Bednarek J, Małecka B, Zabek A. Pacemaker dependency after pacemaker implantation. Cardiol J. 2007;14(1):83-86.

Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton J, Ellenbogen K, Gold M, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):932-987. doi: 10.1016/j.jacc.2018.10.043. DOI: https://doi.org/10.1016/j.jacc.2018.10.043

Epstein AE, DiMarco JP, Ellenbogen KA, Mark Estes NA, Freedman RA, Gettes LS, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation. 2008;117(21):e350-e408. doi: 10.1161/CIRCUALTIONAHA.108.189742. DOI: https://doi.org/10.1161/CIRCUALTIONAHA.108.189742

Nowak B, Misselwitz B; Expert committee 'Pacemaker', Institute of Quality Assurance Hessen, et al. Do gender differences exist in pacemaker implantation?--results of an obligatory external quality control program. Europace. 2010;12(2):210-215. doi: 10.1093/europace/eup312. DOI: https://doi.org/10.1093/europace/eup312

Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003;107(23):2932-2937. doi: 10.1161/01.CIR.0000072769.17295.B1. DOI: https://doi.org/10.1161/01.CIR.0000072769.17295.B1

Schott JJ, Alshinawi C, Kyndt F, Probst V, Hoorntje TM, Hulsbeek M, et al. Cardiac conduction defects associate with mutations in SCN5A. Nat Genet. 1999;23(1):20-21. doi: 10.1038/12618. DOI: https://doi.org/10.1038/12618

Sarzani R, Allevi M, Di Pentima C, Schiavi P, Spannella F, Giulietti F. Role of cardiac natriuretic peptides in heart structure and function. Int J Mol Sci. 2022;23(22):14415. doi: 10.3390/ijms232214415. DOI: https://doi.org/10.3390/ijms232214415

Blanda V, Bracale UM, Di Taranto MD, Fortunato G. Galectin-3 in cardiovascular diseases. Int J Mol Sci. 2020;21(23):9232. doi: 10.3390/ijms21239232. DOI: https://doi.org/10.3390/ijms21239232

Suthahar N, Meijers WC, Silljé HHW, Ho JE, Liu FT, de Boer RA. Galectin-3 activation and inhibition in heart failure and cardiovascular disease: An update. Theranostics. 2018;8(3):593-609. doi: 10.7150/thno.22196. DOI: https://doi.org/10.7150/thno.22196

Bošnjak I, Selthofer-Relatić K, Včev A. Prognostic value of galectin-3 in patients with heart failure. Dis Markers. 2015;2015:690205. doi: 10.1155/2015/690205. DOI: https://doi.org/10.1155/2015/690205

Steyers CM 3rd, Khera R, Bhave P. Pacemaker dependency after cardiac surgery: A Systematic review of current evidence. PLoS One. 2015;10(10):e0140340. doi: 10.1371/journal.pone.0140340. DOI: https://doi.org/10.1371/journal.pone.0140340

Sonou D, Adikpéto F, Hounkponou M, Dossou C, Bokodaho M, Dossou D, et al. Study of Pacing Dependency in Patients with a Cardiac Implanted Electronic Device at the National Teaching Hospital of Cotonou in 2023. World J Cardiovasc Dis. 2025;15:374-381. doi: 10.4236/wjcd.2025.157032. DOI: https://doi.org/10.4236/wjcd.2025.157032

Kiuchi MG, Chen S. Predictors for atrial fibrillation onset in CKD patients with pacemaker. Nephrol Renal Dis. 2017;2(3)1-6. doi: 10.15761/NRD.1000125. DOI: https://doi.org/10.15761/NRD.1000125

Ruiz-Hernandez PM, Gonzalez-Torrecilla E, Gutierrez-Ibañez E, Gonzalez-Saldivar H, Bruña V, Loughlin G, et al. Predictors of pacemaker dependency in patients implanted with a pacemaker after transaortic valve replacement. Int J Cardiol Heart Vasc. 2020;31:100654. doi: 10.1016/j.ijcha.2020.100654. DOI: https://doi.org/10.1016/j.ijcha.2020.100654

Grimm W, Erdmann B, Grimm K, Kreutz J, Parahuleva M. Prognosis of pacing-dependent patients with cardiovascular implantable electronic devices. Herzschrittmacherther Elektrophysiol. 2024;35(1):39-45. doi: 10.1007/s00399-024-00996-1. DOI: https://doi.org/10.1007/s00399-024-00996-1

Dehnavi AM, Fakhrpour A, Tavakoli MB, Nikoo MH. Investigation of the bnp level changes in blood stream in different modes and lead locations after pacemaker implementation. J Med Signals Sens. 2012;2(1):38-41. DOI: https://doi.org/10.4103/2228-7477.108144

Qui N, Wong Y, Jin Y, Liu X, Chen X. Randomized trial of left bundle branch pacing vs. right ventricular pacing in ventricular pacing-dependent patients. Heart Rhythm. 2025;22(4):S787-S788. doi: 10.1016/j.hrthm.2025.03.1895. DOI: https://doi.org/10.1016/j.hrthm.2025.03.1895

Mohtasham Kia Y, Cannavo A, Bahiraie P, Alilou S, Saeedian B, Babajani N, et al. Insights into the role of galectin-3 as a diagnostic and prognostic biomarker of atrial fibrillation. Dis Markers. 2023;2023:2097012. doi: 10.1155/2023/2097012. DOI: https://doi.org/10.1155/2023/2097012

Simu GR, Tomoaia R, Rosu RO, Gusetu G, Puiu M, Cismaru G, et al. Galectin-3, Inflammation, and the Risk of Atrial High-Rate Episodes in Patients with Dual Chamber Pacemakers. Int J Mol Sci. 2023;24(9):7710. doi: 10.3390/ijms24097710. DOI: https://doi.org/10.3390/ijms24097710

Felker GM, Fiuzat M, Shaw LK, Clare R, Whellan DJ, Bettari L, et al. Galectin-3 in ambulatory patients with heart failure: results from the HF-ACTION study. Circ Heart Fail. 2012;5(1):72-78. doi: 10.1161/CIRCHEARTFAILURE.111.963637. DOI: https://doi.org/10.1161/CIRCHEARTFAILURE.111.963637