scholarly journals Presence of contractile impairment appears crucial for structural remodeling in idiopathic left bundle-branch block

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Janek Salatzki ◽  
Theresa Fischer ◽  
Johannes Riffel ◽  
Florian André ◽  
Kristóf Hirschberg ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Left Bundle Branch Block ◽  
Functional Impairment ◽  
Lv Function ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
Structural Remodeling ◽  
Ventricular Asynchrony ◽  
Lv Volumes ◽  
Septal Flash

Abstract Background To differentiate effects of ventricular asynchrony from an underlying hypocontractile cardiomyopathy this study aimed to enhance the understanding of functional impairment and structural remodeling in idiopathic left bundle-branch block (LBBB). We hypothesize, that functional asynchrony with septal flash volume effects alone might not entirely explain the degree of functional impairment. Hence, we suggest the presence of a superimposed contractile cardiomyopathy. Methods In this retrospective study, 53 patients with idiopathic LBBB were identified and matched to controls with and without cardiovascular risk factors. Cardiovascular magnetic resonance (CMR) was used to evaluate cardiac function, volumes and myocardial fibrosis using native T1 mapping and late gadolinium enhancement (LGE). Septal flash volume was assessed by CMR volumetric measurements and allowed to stratify patients with systolic dysfunction solely due to isolated ventricular asynchrony or superimposed contractile impairment. Results Reduced systolic LV-function, increased LV-volumes and septal myocardial fibrosis were found in patients with idiopathic LBBB compared to healthy controls. LV-volumes increased and systolic LV-function declined with prolonged QRS duration. Fibrosis was typically located at the right ventricular insertion points. Subgroups with superimposed contractile impairment appeared with pronounced LV dilation and increased fibrotic remodeling compared to individuals with isolated ventricular asynchrony. Conclusions The presence of superimposed contractile impairment in idiopathic LBBB is crucial to identify patients with enhanced structural remodeling. This finding suggests an underlying cardiomyopathy. Future studies are needed to assess a possible prognostic impact of this entity and the development of heart failure. Trial registration: This study was retrospectively registered.

scholarly journals P782 Septal flash is a prevalent and early dyssynchrony marker in transcatheter aortic valve replacement-induced left bundle branch block

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Calle ◽  
M Coeman ◽  
V Kamoen ◽  
J De Pooter ◽  
F Timmermans
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Bundle Branch Block ◽  
Classical Strain ◽  
Strain Pattern ◽  
Septal Flash

Abstract BACKGROUND New-onset left bundle branch block (LBBB) is a frequent complication after transcutaneous aortic valve replacement (TAVR). LBBB is associated with echocardiographic dyssynchrony in heart failure patients, but this has not been thoroughly investigated in acute LBBB following TAVR. PURPOSE This study aims to assess the timing and incidence of echocardiographic dyssynchrony in acute TAVR-induced LBBB patients. METHODS The study enrolled all TAVR-induced LBBB patients at our Hospital between January 2013 and May 2019. Presence of LBBB was scored within 72 hours following TAVR. Dyssynchrony was assessed by: 1/ presence of septal flash (SF), 2/ interventricular mechanical delay (IVMD, the difference between left and right ventricular pre-ejection interval using pulsed wave Doppler; cut-off ≥40 ms) and 3/ presence of ‘classical dyssynchronous strain pattern’ assessed with speckle tracking (Figure 1). As a control, these three LBBB-related dyssynchrony markers were assessed and compared to LBBB patients without TAVR (non-TAVR patients) in normal ànd reduced EF, but all having SF. RESULTS Out of 134 consecutive TAVR procedures, 30 (22%) were complicated by acute LBBB. SF was present in 72% of TAVR-induced LBBB patients, with a median time from TAVR to SF diagnosis of 24 hours. However, only 1 (5%) of these TAVR patients exhibited a classical dyssynchronous contraction strain pattern (Figure 1), despite presence of SF. Finally, the IVMD values in these TAVR-LBBB patients did not meet the ‘dyssynchrony’ cut-off. As a control, we compared these dyssynchrony parameters in patients with non-TAVR related LBBB with normal and reduced EF, all exhibiting SF. A classical strain pattern was present in 33% of non-TAVR LBBB patients with preserved left ventricular ejection fraction (LV EF) (p = 0.17), and in 80% of non-TAVR LBBB patients with reduced LV EF ≤30% (p < 0.001). The IVMD in non-TAVR LBBB patients with SF and preserved LV EF was 52 ms (p = 0.002) and 57 ms in non-TAVR LBBB patients with SF and LV EF ≤30% (p = 0.009). CONCLUSION SF as dyssynchrony marker develops early after TAVR-induced LBBB and is much more prevalent than the classical strain-based dyssynchrony pattern and IVMD. Our findings from the control population suggest that progressive LBBB-induced LV remodeling (septal thinning and relative lateral thickening) may be required for a ‘classical dyssynchrony strain pattern’ or significant IVMD to occur in TAVR-LBBB patients, but longitudinal follow-up studies in TAVR-LBBB patients are required as proof-of-concept. Abstract P782 Figure 1

Prognosis of incidental left bundle branch block

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 956-963
Author(s):  
Abbasin Zegard ◽  
Osita Okafor ◽  
Joseph de Bono ◽  
Richard Steeds ◽  
Lucy Hudsmith ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Left Bundle Branch Block ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Clinical Events ◽  
Cardiac Symptoms

Abstract Aims Incidental left bundle branch block (iLBBB) is a frequent cause for cardiology referrals. In such instances, there is uncertainty as to its prognosis. We sought to determine the utility of cardiovascular magnetic resonance (CMR) in the risk stratification of patients with iLBBB. Methods and results Clinical events were collected in patients with iLBBB who had CMR. Controls had no cardiac symptoms or cardiac disease, a normal CMR scan and electrocardiogram. Amongst patients with iLBBB [n = 193, aged 62.7 ± 12.6 years (mean ± SD)], 110/193 (56.9%) had an abnormal phenotype (iLBBBCMR+) and 83/110 (43.0%) had a normal phenotype (iLBBBCMR−). Over 3.75 years (median; inter-quartile range: 2.7–5.5), iLBBBCMR+ had a higher total mortality [adjusted hazard ratio (aHR) 6.49, 95% confidence interval (CI) 1.91–22.0] and total mortality or major adverse cardiac events (MACEs; aHR 9.15, 95% CI 2.56–32.6) than controls (n = 107). In contrast, iLBBBCMR− had a similar risk of total mortality compared with controls, but total mortality or MACEs was higher (aHR 4.24, 95% CI 1.17–15.4; P = 0.028). Amongst iLBBB patients, both myocardial fibrosis (aHR 5.15, 95% CI 1.53–17.4) and left ventricular ejection fraction (LVEF)  ≤ 50% (aHR 3.88, 95% CI 1.67–9.06) predicted total mortality. Myocardial fibrosis plus LVEF ≤50% was associated with the highest risk of total mortality (aHR: 9.87, 95% CI 2.99–32.6) and total mortality or MACEs (aHR 3.98, 95% CI 1.73–9.11). Conclusions Outcomes in iLBBBCMR+ were poor whereas survival in iLBBBCMR− was comparable with controls. Myocardial fibrosis and LVEF <50% had an additive effect on the risk of clinical outcomes. A CMR scan is pivotal in risk-stratifying patients with iLBBB.

Neuromuscular comorbidity, atrial fibrillation and left bundle branch block predict the prognosis of left ventricular hypertrabeculation/noncompaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Stoellberger ◽  
M Hasun ◽  
M Winkler-Dworak ◽  
J Finsterer
Keyword(s):  
Atrial Fibrillation ◽  
Left Bundle Branch Block ◽  
Neuromuscular Disorders ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Unknown Etiology ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
Predictors Of Mortality

Abstract Background The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is controversially assessed. LVHT is frequently associated with neuromuscular disorders (NMDs). Aim of the study was to assess cardiac and neurological findings as predictors of mortality in LVHT-patients. Methods Included were patients with LVHT diagnosed between June 1995 and December 2019 in one echocardiographic laboratory. They underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed. Results LVHT was diagnosed in 310 patients (93 female, aged 53±18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 of the investigated patients (16%), NMDs of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During 86 months of follow-up, 59 patients received implanted electronic devices (cardioverter/defibrillator n=21, antibradycardic pacemakers n=11, cardiac resynchronization device/defibrillator n=22, cardiac resynchronization device n=4). During follow-up 105 patients died and 6 patients underwent heart transplantation. The mortality was 4.7%/year. By multivariate analysis, the following baseline parameters were identified as predictors of mortality: increased age (p=0.0005), inpatient-status when LVHT was diagnosed (p=0.0050), presence of a specific NMD (p=0.0187) or NMD of unknown etiology (p=0.0052), atrial fibrillation (p=0.0007) and left bundle branch block (p=0.0168). Conclusions LVHT patients should be systematically investigated neurologically since neurological comorbidity has a prognostic impact. Electrocardiographic abnormalities like atrial fibrillation and left bundle branch block should be considered when planning pharmacotherapy and device-therapy. It has to be assessed by prospective studies, which measures improve the prognosis of LVHT. Funding Acknowledgement Type of funding source: None

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