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

2021 ◽  
Vol 26 (7) ◽  
pp. 4227
Author(s):  
N. E. Shirokov ◽  
V. A. Kuznetsov ◽  
V. V. Todosiychuk ◽  
A. M. Soldatova ◽  
D. V. Krinochkin
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Septal Wall ◽  
Group I

Aim. To assess a relationship of left bundle branch block (LBBB) patterns defined by electrocardiography (ECG) and echocardiography with super-response (SR) to cardiac resynchronization therapy (CRT).Material and methods. Sixty 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: group I (n=31) — decrease of left ventricular end-systolic volume (ESV) ≥30% (super-responders) and II group (n=29) — decrease of LV ESV <30% (non-super-responders). Three strain-markers of LBBB assessed by tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) were used: early contraction of basal or midventricular segment in the septal wall and early stretching of basal or midventricular segment in the lateral wall (marker 1); early peak contraction of the septal wall occurred in the first 70% of the systolic ejection phase (marker 2, septal flash (SF)); early stretching wall that showed peak contraction after aortic valve closure (marker 3). The classical 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 (odds ratio (OR), 7,512; 95% CI, 1,434-39,632; р=0,025), interventricular mechanical delay (OR, 1,037; 95% CI, 1,005-1,071; р=0,017) and longitudinal strain of interventricular septum mid segment (OR, 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 SR prediction were 77,3% and 91,3% (AUC=0,862; p<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.

scholarly journals Relationship of septal flash with electromechanical dyssynchrony and super-response to cardiac resynchronization therapy

2020 ◽  
Vol 5 (2) ◽  
pp. 93-98
Author(s):  
Nikita E. Shirokov ◽  
Vadim A. Kuznetsov ◽  
Lev M. Malishevskii ◽  
Viktor V. Todosiichuk ◽  
Anna M. Soldatova ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Functional Class ◽  
Doppler Imaging ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Group I ◽  
Relationship Of ◽  
Septal Flash

Objectives - to identify a relationship of septal flash (SF) with a super-response to cardiac resynchronization therapy (CRT), apical rocking (AR) and signs of left bundle brunch block (LBBB) in patients with congestive heart failure (CHF). Material and methods. The study included 38 patients (92.1% men; mean age 54.3±9.4 years) with II-IV NYHA functional class CHF. Left bundle brunch block (LBBB) was diagnosed according to 3 criteria: American Heart Association (AHA) 2009, European Society of Cardiology (ESC) 2013, Strauss. Septal flash (SF, mechanical anomaly of interventricular septum (IVS) movement) is determined according to speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI). The patients were divided into two groups: with SF (I group, n=8) and without SF (II group, n=30). Mean follow-up was 34.5 [13.8;55.3]. Results. At baseline the groups did not differ in main clinical characteristics including QRS. The left ventricular (LV) ejection fraction (EF) was higher in group I (33.1%±1.7 and 30.0%±4.0; p=0.044). Basal segment of IVS longitudinal strain (LS) delay by STE (258.0 [144.0;294.0] ms vs 323.5 [273.3;385.0] ms; р=0.024) and LS delay by TDI (176.0 [146.8;287.3] ms vs 415.5 [315.8;493.5] ms; р30%); 53.1% of patients in group II were super responders (р

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.

P1242ECG predictors of outcome in non-left bundle branch block cardiac resynchronization therapy patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A M W Van Stipdonk ◽  
M Dural ◽  
F Salden ◽  
I A H Ter Horst ◽  
H J G M Crijns ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Primary Endpoint ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Qrs Morphology ◽  
Qrs Duration

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

scholarly journals Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation

2020 ◽  
Vol 128 (4) ◽  
pp. 729-738
Author(s):  
Øyvind S. Andersen ◽  
Magnus R. Krogh ◽  
Espen Boe ◽  
Petter Storsten ◽  
John M. Aalen ◽  
...  
Keyword(s):  
Heart Rate ◽  
Cardiac Resynchronization Therapy ◽  
Left Bundle Branch Block ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Cardiac Resynchronization ◽  
Baseline Heart Rate ◽  
Resynchronization Therapy ◽  
Bundle Branch Block

We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at baseline heart rate (120 beats/min) and atrial paced tachycardia (180 beats/min) before and after induction of LBBB and during CRT. LV and left atrial pressures (LAP) were measured by micromanometers and dimensions by sonomicrometry. The time constant τ of exponential pressure decay and degree of incomplete relaxation at mitral valve opening (MVO) and end diastole (ED) based on extrapolation of the exponential decay were assessed. Changes in LV diastolic distensibility were investigated using the LV transmural pressure-volume (PV) relation. LBBB caused prolongation of τ ( P < 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO ( P < 0.001) and ED ( P = 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all P < 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures ( P < 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent. NEW & NOTEWORTHY Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting.

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