{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:46:32Z","timestamp":1772217992025,"version":"3.50.1"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T00:00:00Z","timestamp":1707091200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The fibrosis-4 (FIB-4) index has attracted attention as a predictive factor for cardiovascular events and mortality in patients with heart disease. However, its clinical value in patients with implanted pacemakers remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included patients who underwent pacemaker implantation. The FIB-4 index was calculated based on blood tests performed during the procedure. The primary outcome was all-cause mortality, and the secondary outcomes included cardiovascular death, non-cardiovascular death, and major adverse cardiovascular events (MACE; composite of cardiovascular death, heart failure hospitalization, non-fatal myocardial infarction, and non-fatal stroke). The FIB-4 index was stratified into tertiles. Between-group comparisons were performed using log-rank tests and multivariate analysis using Cox proportional hazards. The predictive accuracy and cut-off value of the FIB-4 index were calculated from the receiver operating characteristic curve for all-cause mortality. Finally, based on the calculated cut-off values, the patients were divided into two groups for outcome validation and subgroup analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      This study included 201 participants, of whom 38 experienced death during the observation period (median: 1097 days). All-cause mortality, non-cardiovascular death, and MACE differed significantly between groups stratified by the FIB-4 index tertiles (log-rank test: P&lt;0.001, P&lt;0.001, and P = 0.045, respectively). Using Cox proportional hazards analysis, the unadjusted hazard ratio was 4.75 (95% confidence interval [CI]: 2.05\u201311.0,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001) for Tertile 3 compared to Tertile 1. After adjustment for confounding factors, including sex, the presence or absence of left bundle branch block at baseline, QRS duration during pacing, and pacing rate at the last check, the hazard ratio was 4.79 (95% CI: 2.04\u201311.2,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). The cut-off value of the FIB-4 index was 3.75 (area under the curve: 0.72, 95% CI: 0.62\u20130.82).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with pacemakers, the FIB-4 index may be a predictor of early all-cause mortality, with a cut-off value of 3.75.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0294221","type":"journal-article","created":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T13:33:22Z","timestamp":1707140002000},"page":"e0294221","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical value of the fibrosis-4 index in predicting mortality in patients with right ventricular pacing"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1521-8833","authenticated-orcid":true,"given":"Naoya","family":"Inoue","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Morikawa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ogane","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehiro","family":"Hiramatsu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-6243","authenticated-orcid":true,"given":"Toyoaki","family":"Murohara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,2,5]]},"reference":[{"key":"pone.0294221.ref001","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1136\/heartjnl-2022-321723","article-title":"Pacing induced cardiomyopathy: recognition and management","volume":"109","author":"SS Ponnusamy","year":"2023","journal-title":"Heart"},{"key":"pone.0294221.ref002","doi-asserted-by":"crossref","first-page":"3641","DOI":"10.1093\/eurheartj\/ehz584","article-title":"Incidence of heart failure after pacemaker implantation: a nationwide Danish registry-based follow-up study","volume":"40","author":"B Tayal","year":"2019","journal-title":"Eur Heart J"},{"key":"pone.0294221.ref003","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1093\/europace\/euac132","article-title":"New-onset atrial fibrillation following left bundle branch area pacing vs. right ventricular pacing: a two-centre prospective cohort study","volume":"25","author":"H Zhu","year":"2023","journal-title":"Europace"},{"key":"pone.0294221.ref004","doi-asserted-by":"crossref","first-page":"3039","DOI":"10.1016\/j.jacc.2019.10.039","article-title":"Left bundle branch pacing: JACC Review Topic of the 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ejection fraction","volume":"8","author":"M Nakashima","year":"2021","journal-title":"ESC Heart Fail"},{"key":"pone.0294221.ref011","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1002\/hep.30223","article-title":"Relationship among fatty liver, specific and multiple-site atherosclerosis, and 10-year Framingham score","volume":"69","author":"R Pais","year":"2019","journal-title":"Hepatology"},{"key":"pone.0294221.ref012","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software \u201cEZR\u201d for medical statistics","volume":"48","author":"Y. Kanda","year":"2013","journal-title":"Bone Marrow Transplant"},{"key":"pone.0294221.ref013","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1007\/s00392-021-01927-7","article-title":"Outcomes of conduction system pacing compared to right ventricular pacing as a primary strategy for treating bradyarrhythmia: systematic review and meta-analysis","volume":"111","author":"A Abdin","year":"2022","journal-title":"Clin Res Cardiol"},{"key":"pone.0294221.ref014","doi-asserted-by":"crossref","first-page":"e000962","DOI":"10.1136\/openhrt-2018-000962","article-title":"Complications and prognosis of patients undergoing apical or septal right ventricular pacing","volume":"6","author":"NB Spath","year":"2019","journal-title":"Open Heart"},{"key":"pone.0294221.ref015","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.4244\/EIJ-D-19-00399","article-title":"Early haemodynamic changes and long-term outcome of patients with severe low-gradient aortic stenosis after transcatheter aortic valve replacement","volume":"15","author":"J Schewel","year":"2020","journal-title":"EuroIntervention"},{"key":"pone.0294221.ref016","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/j.jacc.2020.12.047","article-title":"3-year outcomes of transcatheter mitral valve repair in patients with heart failure","volume":"77","author":"MJ Mack","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"pone.0294221.ref017","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.pcad.2020.02.010","article-title":"FIB-4 stage of liver fibrosis is associated with incident heart failure with preserved, but not reduced, ejection fraction among people with and without HIV or hepatitis C","volume":"63","author":"KA So-Armah","year":"2020","journal-title":"Prog Cardiovasc Dis"},{"key":"pone.0294221.ref018","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1172\/JCI24282","article-title":"Liver fibrosis","volume":"115","author":"R Bataller","year":"2005","journal-title":"J Clin Invest"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294221","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,5]],"date-time":"2024-02-05T13:33:36Z","timestamp":1707140016000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294221"}},"subtitle":[],"editor":[{"given":"Zhehao","family":"Dai","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,2,5]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0294221","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2023.10.30.23297769","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,5]]}}}