scholarly journals Morphologies and prognostic significance of left ventricular volume/time curves with cardiac magnetic resonance in patients with non-ischaemic heart failure and left bundle branch block

2021 ◽  
Author(s):  
Alberto Aimo ◽  
Alessandro Valleggi ◽  
Andrea Barison ◽  
Sara Salerni ◽  
Michele Emdin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Bundle Branch Block ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Rate Of Change ◽  
Cardiac Resynchronization ◽  
Bundle Branch Block ◽  
Dyssynchrony Index

AbstractPatients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB) can display a wide or narrow pattern (WP/NP) of the systolic phase of the left ventricular (LV) volume/time (V/t) curve in cardiac magnetic resonance (CMR). The clinical and prognostic significance of these patterns is unknown. Consecutive patients with non-ischaemic HF, LV ejection fraction < 50% and LBBB underwent 1.5 T CMR. Maximal dyssynchrony time (time between the earliest and latest end-systolic peaks), systolic dyssynchrony index (standard deviation of times to peak volume change), and contractility index (maximum rate of change of pressure-normalized stress) were calculated. The endpoint was a composite of cardiovascular death, HF hospitalization, and appropriate defibrillator shock. NP was found in 29 and WP in 72 patients. WP patients had higher volumes and NT-proBNP, and lower LVEF. WP patients had a longer maximal dyssynchrony time (absolute duration: 192 ± 80 vs. 143 ± 65 ms, p < 0.001; % of RR interval: 25 ± 11% vs. 8 ± 4%, p < 0.001), a higher systolic dyssynchrony index (13 ± 4 vs. 7 ± 3%, p < 0.001), and a lower contractility index (2.6 ± 1.2 vs 3.2 ± 1.7, p < 0.05). WP patients had a shorter survival free from the composite endpoint regardless of age, NT-proBNP or LVEF. Nonetheless, WP patients responded more often to cardiac resynchronization therapy (CRT) than those with NP (24/28 [86%] vs. 1/11 [9%] responders, respectively; p < 0.001). In patients with non-ischaemic systolic HF and LBBB, the WP of V/t curves identifies a subgroup of patients with greater LV dyssynchrony and worse outcome, but better response to CRT.

P597Clinical and prognostic correlates of volume/time curve at cardiac magnetic resonance in patients with non-ischemic heart failure and left bundle branch block

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Aimo ◽  
A Barison ◽  
A Valleggi ◽  
S Salerni ◽  
R De Caterina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Bundle Branch Block ◽  
Prognostic Significance ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Time Curve ◽  
Bundle Branch Block

Abstract Background In patients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB), the systolic phase of the left ventricular (LV) volume/time (V/t) curve at cardiac magnetic resonance (CMR) can display a wide or a narrow pattern (WP/NP). The clinical and prognostic significance of these patterns are currently unknown. Methods Consecutive patients with systolic non-ischaemic HF (LV ejection fraction <50%) and LBBB were enrolled. They underwent a baseline evaluation including CMR, and were periodically re-evaluated during follow-up. The endpoint was a composite of cardiovascular death, heart failure (HF)-related event, and ventricular arrhythmias requiring defibrillator shock. Results Out of 101 patients (mean age 64±11 years, males 50%), NP was found in 29 and WP in 72, with no difference in QRS duration. Patients with WP had worse clinical presentation and greater LV volumes, but similar LGE prevalence, extent or distribution. The WP subgroup displayed a greater maximal dyssynchrony time, expressed both as absolute duration (192±80 vs. 143±65 ms, P<0.001), and as percentage of the RR interval (25±11% vs. 8±4%, p<0.001). Even the systolic dyssynchrony index was higher in patients with WP (13±4 vs. 7±3%, p<0.001). The contractility index was lower in patients with the WP (2.6±1.2 vs 3.2±1.7, p<0.05). Over a median follow-up duration of 44 months (interquartile interval 23–59), only WP (p=0.029) and NT-proBNP (p=0.004) demonstrated an independent prognostic value for cardiac events. Conclusions In patients with non-ischaemic systolic HF and LBBB, the WP of V/t curves identifies a subgroup of patients with greater LV dyssynchrony, worse clinical conditions and prognosis.

scholarly journals Relationship between left bundle branch block mechanical patterns and super-response to cardiac resynchronization therapy in patients with congestive heart failure

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Shirokov ◽  
V Kuznetsov ◽  
V Todosiichuk ◽  
A Soldatova ◽  
D Krinochkin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Bundle Branch Block ◽  
Clinical Guidelines ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Bundle Branch Block ◽  
Septal Wall ◽  
Group I

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch block (LBBB) assessed by electrocardiography (ECG) is used in current clinical guidelines for patient selection to cardiac resynchronisation therapy (CRT). But percentage of non-responders among patients with congestive heart failure is high. Super-response (SR) to CRT was not enough described in clinical guidelines. We hypothesized that mechanical patterns of LBBB and parameters of mechanical dyssynchrony could be used as predictors of SR to CRT. Aim To assess a relationship of LBBB patterns defined by ECG and echocardiography with SR to CRT. Materials and methods 60 patients (mean age 54.5 ± 10.4 years) were examined at baseline and during follow-up: 10.6 ± 3.6 months. Patients were divided into groups: I group (n = 31) with decrease of left ventricular end-systolic volume (ESV) ≥30% (super-responders) and II group (n = 29) - decrease of LV ESV &lt;30% (non-super-responders). Three strain-markers of LBBB assessed by Tissue Doppler Imaging (TDI) and Speckle Tracking Echocardiography (STE) were used: (1) early contraction of basal or midventricular segment in the septal wall and early stretching of basal or midventricular segment in the lateral wall (yellow arrows); (2) the early peak contraction of the septal wall occurred in the first 70% of the systolic ejection phase (blue arrow); (3) the early stretching wall that showed peak contraction after aortic valve closure (red arrows). The classic LBBB pattern was defined if all three strain-markers were present. The heterogeneous LBBB pattern was defined if two from three strain-markers were present. Results At baseline groups did not differ in main clinical characteristics, including QRS width and LBBB assessed by ECG. Mechanical abnormalities were found only in group I: SF (32.3% vs 0.0%; p = 0.001) and apical rocking (19.4% vs 0.0%; p = 0.024), as well as classic LBBB mechanical pattern (20.8% vs 0.0%; p = 0.05). The complex of heterogeneous LBBB mechanical pattern (HR 7.512; 95% CI 1.434 – 39.632; р=0.025), interventricular mechanical delay (HR 1.037; 95% CI 1.005 – 1.071; р=0.017) and longitudinal strain of interventricular septum mid segment (HR 0.726; 95% CI 0.540 – 0.977; р=0.035) had an independent relationship with SR. According to the ROC analysis the sensitivity and specificity of model in the prediction of SR were 77.3% and 91.3% (AUC = 0.862; p &lt; 0.001). Conclusion SR is associated with both LBBB mechanical patterns assessed by STE and TDI. LBBB defined by ECG did not have significant association with SR to CRT. Abstract Figure.

scholarly journals Regional myocardial work as determinant of heart failure in left bundle branch block

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
OJ Sletten ◽  
JM Aalen ◽  
H Izci ◽  
J Duchenne ◽  
EW Remme ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
Contractile Function ◽  
Myocardial Strain ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Public Institution ◽  
Cardiac Resynchronization ◽  
Wall Function ◽  
Bundle Branch Block

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The Norwegian Health Association Background Left bundle branch block (LBBB) worsen prognosis in heart failure patients. LBBB may also cause heart failure in otherwise healthy individuals. The mechanical changes induced by LBBB are potential determinants of heart failure in these patients, but their relation to left ventricular (LV) systolic function is incompletely understood. Purpose This study investigates the contribution of regional contractile function to heart failure in patients with LBBB. Methods In 76 patients with LBBB and 11 healthy controls, myocardial strain was measured by speckle-tracking echocardiography and myocardial work by pressure-strain analysis. Patients with ischemic heart disease or myocardial scarring were excluded. LBBB patients were stratified by LV ejection fraction (EF) &gt;50% (EFpreserved), 36-50% (EFmid), and ≤35% (EFlow). 62 LBBB patients subsequently underwent cardiac resynchronization therapy (CRT) implantation and was re-examined at 6 months. Results Septal work was significantly and successively reduced from controls, EFpreserved, EFmid, to EFlow (1977 ± 506, 1025 ± 342, 601 ± 494 and -41 ± 303 mmHg·%, respectively, all p &lt; 0.01) (Figure 1). There was a strong correlation (R = 0.84, p &lt; 0.01) between septal work and LVEF. In contrast, work in the LV lateral wall was preserved in both EFpreserved (2367 ± 459 mmHg·%) and EFmid (2252 ± 449 mmHg·%) vs controls (2062 ± 459 mmHg·%, all NS). In the EFlow group, however, LV lateral wall work was reduced (1473 ± 568 mmHg·%, p &lt; 0.01 vs controls). Thus, lateral wall function was not correlated with LVEF in patients with LVEF &gt;35% (NS). At six month CRT septal work was markedly increased (165 ± 485 vs 1288 ± 523 mmHg·%, p &lt; 0.01) and LV lateral wall work reduced (1730 ± 620 vs 1264 ± 490 mmHg·%, p &lt; 0.01). LVEF increased from 32 ± 8 to 47 ± 10 % (p &lt; 0.01). Conclusions Heart failure in LBBB patients is determined by degree of septal dysfunction. LV lateral wall function, on the other hand, is preserved in the early phase of heart failure and was only reduced in patients with severe heart failure. Further clinical studies should investigate if measuring LV lateral wall function can increase precision in patient selection for CRT. Abstract Figure.

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