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Wang X, Ge B, Miao C, Lee C, Romero JE, Li P, Wang F, Xu D, Chen M, Li D, Li D, Li M, Xu F, Li Y, Gong C, Taub CC, Yao J. Beyond conduction impairment: Unveiling the profound myocardial injury in left bundle branch block. Heart Rhythm 2024; 21:1370-1379. [PMID: 38490601 DOI: 10.1016/j.hrthm.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Left bundle branch block (LBBB) represents a frequently encountered conduction system disorder. Despite its widespread occurrence, a continual dilemma persists regarding its intricate association with underlying cardiomyopathy and its pivotal role in the initiation of dilated cardiomyopathy. The pathologic alterations linked to LBBB-induced cardiomyopathy (LBBB-CM) have remained elusive. OBJECTIVE This study sought to investigate the chronologic dynamics of LBBB to left ventricular dysfunction and the pathologic mechanism of LBBB-CM. METHODS LBBB model was established through main left bundle branch trunk ablation in 14 canines. All LBBB dogs underwent transesophageal echocardiography and electrocardiography before ablation and at 1 month, 3 months, 6 months, and 12 months after LBBB induction. Single-photon emission computed tomography imaging was performed at 12 months. We then harvested the heart from all LBBB dogs and 14 healthy adult dogs as normal controls for anatomic observation, Purkinje fiber staining, histologic staining, and connexin43 protein expression quantitation. RESULTS LBBB induction caused significant fibrotic changes in the endocardium and mid-myocardium. Purkinje fibers exhibited fatty degeneration, vacuolization, and fibrosis along with downregulated connexin43 protein expression. During a 12-month follow-up, left ventricular dysfunction progressively worsened, peaking at the end of the observation period. The association between myocardial dysfunction, hypoperfusion, and fibrosis was observed in the LBBB-afflicted canines. CONCLUSION LBBB may lead to profound myocardial injury beyond its conduction impairment effects. The temporal progression of left ventricular dysfunction and the pathologic alterations observed shed light on the complex relationship between LBBB and cardiomyopathy. These findings offer insights into potential mechanisms and clinical implications of LBBB-CM.
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Affiliation(s)
- Xiaoxian Wang
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Beibei Ge
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Changqing Miao
- Department of Cardiology, Jiangyin People's Hospital, Jiangyin, People's Republic of China
| | - Christopher Lee
- Department of Cardiology, University of California, San Francisco, California
| | - Jorge E Romero
- Cardiac Arrhythmia Service, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peng Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Di Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dianfu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Dong Li
- Harbor-UCLA Medical Center, Torrance, California
| | - Mingxia Li
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Fang Xu
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China
| | - Yan Li
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Chanjuan Gong
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Cynthia C Taub
- Department of Medicine, Upstate Medical University, Norton College of Medicine, Syracuse, New York
| | - Jing Yao
- Department of Ultrasound Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China; Medical Imaging Center, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China.
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Kloosterman M, Loh KP, van Veen TAB. Left bundle branch block-induced cardiomyopathy: A distinctive form of cardiomyopathy that might require a dedicated form of treatment. Heart Rhythm 2024; 21:1380-1381. [PMID: 38608919 DOI: 10.1016/j.hrthm.2024.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Manon Kloosterman
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - K Peter Loh
- Division of Heart & Lungs, Department of Cardiology, University Medical Center Utrecht, The Netherlands
| | - Toon A B van Veen
- Division of Heart & Lungs, Department of Medical Physiology, University Medical Center Utrecht, The Netherlands.
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3
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Pastorini G, Anastasio F, Botto A, Tardivo V, Feola M. Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain. J Geriatr Cardiol 2024; 21:760-767. [PMID: 39183950 PMCID: PMC11341527 DOI: 10.26599/1671-5411.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block (LBBB) have to be stratified for the presence of coronary artery disease and the risk of developing heart failure (HF). We investigated the prognostic role of coronary CT-angiography (CTA) and echocardiographic global longitudinal strain (GLS) in those patients in a mid-term follow-up. Methods Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated retrospectively. Development of HF or a cardiovascular death were the events scheduled. Results Seventy-eight patients (32 female; mean age: 66.0 ± 10.4 years were enrolled. During a follow-up of 33 months (IQR: 17-77), one patient (1.5%) experienced a cardiovascular death, 14 patients (17.9%) required urgent outpatient visits due to acute decompensated HF (12 hospitalizations). Echocardiography showed a slightly reduced left ventricular ejection fraction (LVEF) (50.0% ± 9.8%) and GLS within the normal range (-16.2% ± 4.1%). CTA analysis showed coronary stenosis > 50% in 28 patients (35.9%). A high Agatston score (> 100) was observed in 29.5%. Notably, 25 patients (32.1%) were diagnosed with left main coronary artery disease and 15 patients (16.7%) underwent revascularization during the follow up. Significant associations were observed between events and LVEF (P = 0.001), diastolic dysfunction grade ≥ 2 (P = 0.02), GLS (P < 0.001), multiple coronary stenosis (P = 0.04) and Agatston score (P = 0.05). Multivariate analysis confirmed the relationships with LVEF (R2 = 0.89, P < 0.001), diastolic dysfunction (R2 = 3.30, P = 0.04), GLS (R2 = 1.43, P < 0.001), and Agatston score (R2 = 1.01, P = 0.05). Conclusions In patients with complete LBBB, CTA and GLS identified those at a high risk of development HF.
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Affiliation(s)
- Guido Pastorini
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
| | - Fabio Anastasio
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
| | - Anna Botto
- Intensive Care, Regina Montis Regalis Hospital, ASLCN1 Mondovi’, Italy
| | | | - Mauro Feola
- Cardiology Division, Regina Montis Regalis Hospital, ASLCN1, Mondovi’, Italy
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4
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Donelli D, Antonelli M, Gurgoglione FL, Lazzeroni D, Niccoli G, Cortigiani L, Gaibazzi N. Effects of left bundle branch block on echocardiographic coronary flow assessment: A systematic review. Echocardiography 2024; 41:e15864. [PMID: 38889092 DOI: 10.1111/echo.15864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/13/2024] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
This systematic review investigates the diagnostic and prognostic utility of coronary flow reserve (CFR) assessment through echocardiography in patients with left bundle branch block (LBBB), a condition known to complicate the clinical evaluation of coronary artery disease (CAD). The literature search was performed on PubMed, EMBASE, Web of Science, Scopus, and Google Scholar, was guided by PRISMA standards up to March 2024, and yielded six observational studies that met inclusion criteria. These studies involved a diverse population of patients with LBBB, employing echocardiographic protocols to clarify the impact of LBBB on coronary flow dynamics. The findings emphasize the importance of CFR in stratifying cardiovascular risk and guiding clinical decision-making in patients with LBBB. Pooled results reveal that patients with LBBB and significant left anterior descending (LAD) artery stenosis exhibited a marked decrease in stress-peak diastolic velocity (MD = -19.03 [-23.58; -14.48] cm/s; p < .0001) and CFR (MD = -.60 [-.71; -.50]; p < .0001), compared to those without significant LAD lesions, suggesting the efficacy of stress echocardiography CFR assessment in the identification of clinically significant CAD among the LBBB population. This review highlights the clinical relevance of echocardiography CFR assessment as a noninvasive tool for evaluating CAD and stratifying risk in the presence of LBBB and underscores the need for standardized protocols in CFR measurement.
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Affiliation(s)
- Davide Donelli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiology Unit, University Hospital of Parma, Parma, Italy
| | - Michele Antonelli
- Department of Public Health, AUSL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Filippo Luca Gurgoglione
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiology Unit, University Hospital of Parma, Parma, Italy
| | - Davide Lazzeroni
- Prevention and Rehabilitation Unit, IRCCS Fondazione Don Gnocchi, Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Cardiology Unit, University Hospital of Parma, Parma, Italy
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Zou JH, Hua BT, Shao XX, Wang C, Li H, Lu YN, Tian X, Li ZX, Pu LJ, Wang J. Redefining left bundle branch block from high-density electroanatomical mapping. Int J Cardiol 2024; 402:131830. [PMID: 38320669 DOI: 10.1016/j.ijcard.2024.131830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND The existing ECG criteria for diagnosing left bundle branch block (LBBB) are insufficient to distinguish between true and false blocks accurately. METHODS We hypothesized that the notch width of the QRS complex in the lateral leads (I, avL, V5, V6) on the LBBB-like ECG could further confirm the diagnosis of true complete left bundle branch block (t-LBBB). We conducted high-density, three-dimensional electroanatomical mapping in the cardiac chambers of 37 patients scheduled to undergo CRT. These patients' preoperative electrocardiograms met the ACC/AHA/HRS guidelines for the diagnosis of complete LBBB. If the left bundle branch potential could be mapped from the base of the heart to the apex on the left ventricular septum, it was defined as a false complete left bundle branch block (f-LBBB). Otherwise, it was categorized as a t-LBBB. We conducted a comparative analysis between the two groups, considering the clinical characteristics, real-time correspondence between the spread of ventricular electrical excitation and the QRS wave, QRS notch width of the lateral leads (I, avL, V5, V6), and the notch width/left ventricular end-diastolic diameter (Nw/LVd) ratio. We performed the ROC correlation analysis of Nw/LVd and t-LBBB to determine the sensitivity and specificity for diagnostic authenticity. RESULTS Twenty-five patients were included in the t-LBBB group, while 12 patients were assigned to the f-LBBB group. Within the t-LBBB group, the first peak of the QRS notch correlated with the depolarization of the right ventricle and septum, the trough corresponded to the depolarization of the left ventricle across the left ventricle, and the second peak aligned with the depolarization of the left ventricular free wall. In contrast, within the f-LBBB group, the first peak coincided with the depolarization of the right ventricle and a majority of the left ventricle, the second peak occurred due to the depolarization of the latest, locally-activated myocardium in the left ventricle, and the trough was a result of delayed activation of the left ventricle that did not align with the usual peak timing. The QRS notch width (45.2 ± 12.3 ms vs. 52.5 ± 9.2 ms, P < 0.05) and the Nw/LVd ratio (0.65 ± 0.19 ms/mm vs. 0.81 ± 0.17 ms/mm, P < 0.05) were compared between the two groups. After conducting the ROC correlation analysis, a sensitivity of 56% and a specificity of 91.7% for diagnosing t-LBBB using Nw/LVd were obtained. CONCLUSION By utilizing the current diagnostic criteria for LBBB, an increased Nw/LVd value can enhance the effectiveness of diagnosing LBBB.
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Affiliation(s)
- Jun-Hua Zou
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Bao-Tong Hua
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiao-Xia Shao
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chao Wang
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hao Li
- The third Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ya-Nan Lu
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Tian
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Xuan Li
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li-Jin Pu
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Jing Wang
- The first Department of Cardiology, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Tamargo M, Gutiérrez-Ibañes E. Left Bundle Branch Block in Aortic Stenosis: Implications Beyond Pacemaker Implantation. JACC. ASIA 2024; 4:320-322. [PMID: 38660102 PMCID: PMC11035939 DOI: 10.1016/j.jacasi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- María Tamargo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Gutiérrez-Ibañes
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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7
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Gatti P, Lind S, Kristjánsdóttir I, Azari A, Savarese G, Anselmino M, Linde C, Gadler F. Prognosis of CRT-treated and CRT-untreated unselected population with LBBB in Stockholm County. Europace 2023; 25:euad192. [PMID: 37403689 PMCID: PMC10365846 DOI: 10.1093/europace/euad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 07/06/2023] Open
Abstract
AIMS Left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but also the prerequisite for cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). The prognosis for patients with LBBB and the implications of CRT in an unselected real-world setting are the focus of our study. METHODS AND RESULTS A central electrocardiogram (ECG) database and national registers have been screened to identify patients with LBBB. Predictors of HF and the use of CRT were identified with Cox models. The hazard ratios (HRs) of death, cardiovascular death (CVD), and HF hospitalization (HFH) were estimated according to CRT use. Of 5359 patients with LBBB and QRS > 150 ms, median age 76 years, 36% were female. At the time of index ECG, 41% had a previous history of HF and 27% developed HF. Among 1053 patients with a class I indication for CRT, only 60% received CRT with a median delay of 137 days, and it was associated with a lower risk of death [HR: 0.45, 95% confidence interval (CI): 0.36-0.57], CVD (HR: 0.47, 95% CI: 0.35-0.63), and HFH (HR: 0.56, 95% CI: 0.48-0.66). The age of over 75 years and the diagnosis of dementia and chronic obstructive pulmonary disease were predictors of CRT non-use, while having a pacing/defibrillator device independently predicted CRT use. CONCLUSION In an unselected LBBB population, CRT is underused but of great value for HF patients. Therefore, it is crucial to find ways of better implementing and understanding CRT utilization and characteristics that influence the management of our patients.
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Affiliation(s)
- Paolo Gatti
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
| | - Stefan Lind
- Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Ingibjörg Kristjánsdóttir
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
| | - Ava Azari
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
- Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, University of Turin, Azienda Ospedaliero Universitaria (A.O.U.) Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Cecilia Linde
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
- Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
| | - Fredrik Gadler
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden
- Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden
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Sidrak MMA, De Feo MS, Gorica J, Corica F, Conte M, Filippi L, De Vincentis G, Frantellizzi V. Medication and ECG Patterns That May Hinder SPECT Myocardial Perfusion Scans. Pharmaceuticals (Basel) 2023; 16:854. [PMID: 37375801 DOI: 10.3390/ph16060854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/24/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary artery disease (CAD) is the leading cause of death followed by cancer, in men and women. With risk factors being endemic and the increasing costs of healthcare for management and treatment, myocardial perfusion imaging (MPI) finds a central role in risk stratification and prognosis for CAD patients, but it comes with its limitations in that the referring clinician and managing team must be aware of and use at their advantage. This narrative review examines the utility of myocardial perfusion scans in the diagnosis and management of patients with ECG alterations such as atrioventricular block (AVB), and medications including calcium channel blockers (CCB), beta blockers (BB), and nitroglycerin which may impact the interpretation of the exam. The review analyzes the current evidence and provides insights into the limitations, delving into the reasons behind some of the contraindications to MPI.
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Affiliation(s)
- Marko Magdi Abdou Sidrak
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Maria Silvia De Feo
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Joana Gorica
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Ferdinando Corica
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Miriam Conte
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Luca Filippi
- Department of Nuclear Medicine, Santa Maria Goretti Hospital, 04100 Latina, Italy
| | - Giuseppe De Vincentis
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
| | - Viviana Frantellizzi
- Department of Radiological Sciences, Oncology and Anatomo-Pathology, Sapienza, University of Rome, 00161 Rome, Italy
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9
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Holm JT, Stampe NK, Bhardwaj P, Jabbari R, Gustafsson F, Risum N, Tfelt-Hansen J, Winkel BG. Bundle branch block in cardiac arrest survivors without ischemic heart disease. IJC HEART & VASCULATURE 2023; 45:101188. [PMID: 36896255 PMCID: PMC9989659 DOI: 10.1016/j.ijcha.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
Aims Cardiac arrest (CA) survivors with left/right bundle branch block (LBBB/RBBB) and no ischemic heart disease (IHD) have not been previously characterized. The aim of this study was to describe heart failure, implantable cardioverter defibrillator (ICD) therapy and mortality in this population. Methods Between 2009 and 2019 we consecutively identified all CA survivors with a consistent bundle branch block (BBB) defined as a QRS ≥ 120 ms, who had a secondary prophylactic ICD implanted. Patients with congenital and ischemic heart disease (IHD) were excluded. Results Among 701 CA-survivors who survived to discharge and received an ICD, a total of 58 (8%) were free from IHD and had BBB; 46 (79%) had LBBB, 10 (17%) had RBBB and 2 (3%) had non-specific BBB (NSBBB). The prevalence of LBBB was 7%. Pre-arrest ECG were available in 34 (59%) patients; 20 patients (59%) had LBBB, 6 (18%) had RBBB, 2 (6%) had NSBBB, 1 had (3%) incomplete LBBB, and 4 (12%) without BBB. At discharge, patients with LBBB had a significantly lower left ventricular ejection fraction (LVEF) than patients with other types of BBB, p < 0.001. During follow-up, 7 (12%) died after a median of 3.6 years (IQR: 2.6-5.1) with no difference between BBB subtypes. Conclusion We identified 58 CA-survivors with BBB and no IHD. The prevalence of LBBB among all CA-survivors was high, 7%. During CA hospitalization LBBB patients presented with a significantly lower LVEF than patients with other types of BBB (P < 0.001). ICD treatment and mortality did not differ between BBB subtypes during follow-up.
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Affiliation(s)
- Julie Terp Holm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Blegdamsvej 3, 2100 Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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Gao Y, Zhang Y, Tang Y, Wu H, Xu F, Hong J, Xu D. Myocardial work and energy loss of left ventricle obtained by pressure-strain loop and vector flow mapping: a new perspective on idiopathic left bundle branch block. Quant Imaging Med Surg 2023; 13:210-223. [PMID: 36620173 PMCID: PMC9816760 DOI: 10.21037/qims-22-284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022]
Abstract
Background To date, no research has been conducted on the electrical activity and mechanical dyssynchrony of idiopathic left bundle branch block (iLBBB) with normal left ventricular ejection fraction (LVEF). This study sought to assess the left ventricular summation of energy loss (EL-SUM) and average energy loss (EL-AVE) using vector flow mapping as well as myocardial work using pressure-strain loop (PSL) in patients with iLBBB and normal LVEF. Methods We prospectively recruited 35 patients with iLBBB and 35 control participants with normal LVEF. Echocardiography was performed. Conventional echocardiographic parameters, myocardial work, and energy loss (i.e., the EL-SUM and EL-AVE) were calculated. Results In relation to global myocardial work, compared to the control participants, the iLBBB patients showed decreased global longitudinal strain (GLS; -15.32%±2.58% vs. -18.27%±2.12%; P=0.001), a decreased global work index (GWI; 1,428.24±338.18 vs. 1,964.87±264.16 mmHg%; P<0.001), decreased global work efficiency (GWE) (84.48±5.19 vs. 91.73±5.31 mmHg%; P<0.001), and significantly increased global waste work (GWW; 341.60±132.62 vs. 161.80±106.81 mmHg%; P<0.001). In relation to the regional index, the iLBBB patients had a significantly reduced basal anteroseptal segment (879.15±370.50 vs. 1,746.38±154.44 mmHg%; P<0.001), basal inferoseptal segment (1,111.42±389.04 vs. 1,677.25±223.10 mmHg%; P<0.001), mid-anteroseptal segment (1,097.54±394.83 vs. 1,815.06±291.22 mmHg%; P<0.001), mid-inferoseptal segment (1,012.54±353.33 vs. 1,880.88±254.39 mmHg%; P<0.001), apical anterior segment (1,592.42±366.64 vs. 1,910.00±170.27 mmHg%; P=0.001), apical lateral segment (1,481.62±342.95 vs. 1,817.19±227.55 mmHg%; P=0.001), apical septal segment (1,437.65±428.22 vs. 1,852.25±275.19 mmHg%; P=0.001), and apex (1,542.62±342.89 vs. 1,907.06±197.94 mmHg%; P<0.001). The iLBBB patients had increased EL-AVE and EL-SUM during the late-diastole, isovolumic-systole, and rapid-ejection periods [EL-AVE in T2: 28.3 (8.7, 49.0) vs. 6.8 (5.4, 9.4) J/(s·m3); P=0.029]; [EL-AVE in T3: 24.7 (13.0, 46.8) vs. 7.2 (5.4, 10.8) J/(s·m3), P<0.001]; [EL-AVE in T4: 18.3 (12.0, 27.6) vs. 7.7 (4.1, 11.6) J/(s·m3), P=0.002]; [EL-SUM in T2: 8.3 (2.2, 14.5) vs. 2.1 (1.6, 3.2) J/(s·m), P=0.049]; [EL-SUM in T3: 7.6 (4.0, 14.5) vs. 2.2 (1.7, 3.3) J/(s·m), P<0.001]; [EL-SUM in T4: 5.3 (3.6, 9.7) vs. 2.2 (1.4, 3.0) J/(s·m), P=0.004]. Conclusions The GWI and GWE were reduced in patients with iLBBB, especially in the septum and apex. The EL-SUM and EL-AVE were higher in patients with iLBBB during the late-diastole, isovolumic-systole, and rapid-ejection periods. EL and PSL reflect the LV hemodynamics of patients with iLBBB.
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Affiliation(s)
- Yu Gao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China;,Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yanjuan Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yihu Tang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongping Wu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Xu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Hong
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Xu
- Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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11
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Petersen A, Nagel SN, Hamm B, Elgeti T, Schaafs LA. Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging. Front Cardiovasc Med 2022; 9:977414. [PMID: 36337885 PMCID: PMC9631472 DOI: 10.3389/fcvm.2022.977414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images. Materials and methods Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash). Results Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44–20.44%); LBBB without artefact: 6.82% (-2.18–15.83%); controls: 4.38% (1.38–7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05). Conclusion Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.
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12
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Kitsou V, Blomberg B, Lunde T, Saeed S. Intermittent left bundle branch block with septal flash and postural orthostatic tachycardia syndrome in a young woman with long COVID-19. BMJ Case Rep 2022; 15:15/6/e249608. [PMID: 35672052 PMCID: PMC9174810 DOI: 10.1136/bcr-2022-249608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The emerging entity, long COVID -19 is characterised by long-lasting dyspnoea, fatigue, cognitive dysfunction and other symptoms. Cardiac involvement manifested as conduction abnormalities, left ventricle mechanical dyssynchrony, dyspnoea, palpitation and postural orthostatic tachycardia syndrome (POTS) are common in long COVID-19. The direct viral damage to the myocardium or immune-mediated inflammation are postulated mechanisms. A woman in her forties presented with a 2-month history of chest pain, functional dyspnoea, palpitation and an episode of syncope after having been home-isolated for mild COVID infection. During clinical workup, a clustering of ECG and echocardiographic abnormalities including left bundle branch block, septal flash, and presystolic wave on spectral Doppler echocardiography, and POTS were detected. The echocardiographic findings together with POTS and persistent dyspnoea indicated the presence of a long COVID-19 state. The prevalence and clinical significance of these finding, as well as the impact on long-term prognosis, should be investigated in future studies.
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Affiliation(s)
- Vasiliki Kitsou
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Emergency Care Clinic, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Blomberg
- Department of Clinical Science, University of Bergen, Bergen, Norway
- National Advisory Unit for Tropical Infectious Diseases, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Torbjørn Lunde
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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13
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Wickramasinghe NL, Athif M. Multi-label classification of reduced-lead ECGs using an interpretable deep convolutional neural network. Physiol Meas 2022; 43. [PMID: 35617943 DOI: 10.1088/1361-6579/ac73d5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022]
Abstract
Objective. We propose a model that can perform multi-label classification on 26 cardiac abnormalities from reduced lead Electrocardiograms (ECGs) and interpret the model.Approach. PhysioNet/Computing in Cardiology (CinC) challenge 2021 datasets are used to train the model. All recordings shorter than 20 seconds are preprocessed by normalizing, resampling, and zero-padding. The frequency domains of the recordings are obtained by applying Fast Fourier Transform. The time domain and frequency domain of the signals are fed into two separate deep convolutional neural networks. The outputs of these networks are then concatenated and passed through a fully connected layer that outputs the probabilities of 26 classes. Data imbalance is addressed by using a threshold of 0.13 to the sigmoid output. The 2-lead model is tested under noise contamination based on the quality of the signal and interpreted using SHapley Additive exPlanations (SHAP).Main results. The proposed method obtained a challenge score of 0.55, 0.51, 0.56, 0.55, and 0.56, ranking 2nd, 5th, 3rd, 3rd, and 3rd out of 39 officially ranked teams on 12-lead, 6-lead, 4-lead, 3-lead, and 2-lead hidden test datasets, respectively, in the PhysioNet/CinC challenge 2021. The model performs well under noise contamination with mean F1 scores of 0.53, 0.56 and 0.56 for the excellent, barely acceptable and unacceptable signals respectively. Analysis of the SHAP values of the 2-lead model verifies the performance of the model while providing insight into labeling inconsistencies and reasons for the poor performance of the model in some classes.Significance. We have proposed a model that can accurately identify 26 cardiac abnormalities using reduced lead ECGs that performs comparably with 12-lead ECGs and interpreted the model behavior. We demonstrate that the proposed model using only the limb leads performs with accuracy comparable to that using all 12 leads.
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Affiliation(s)
- Nima Lakmina Wickramasinghe
- Department of Electronic and Telecommunication Engineering, University of Moratuwa, Bandaranayake Mawatha, Moratuwa, 10400, SRI LANKA
| | - Mohamed Athif
- Biomedical Engineering, Boston University, 44, Cummington Mall, Boston, Massachusetts, 02215-1300, UNITED STATES
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14
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Andersen DC, Kragholm K, Petersen LT, Graff C, Sørensen PL, Nielsen JB, Pietersen A, Søgaard P, Atwater BD, Friedman DJ, Torp-Pedersen C, Polcwiartek C. Association between vectorcardiographic QRS area and incident heart failure diagnosis and mortality among patients with left bundle branch block: A register-based cohort study. J Electrocardiol 2021; 69:30-35. [PMID: 34547542 DOI: 10.1016/j.jelectrocard.2021.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND QRS duration and morphology including left bundle branch block (LBBB) are the most widely used electrocardiogram (ECG) markers for assessing ventricular dyssynchrony and predicting heart failure (HF). However, the vectorcardiographic QRS area may more accurately identify delayed left ventricular activation and HF development. OBJECTIVE We investigated the association between QRS area and incident HF risk in patients with LBBB. METHODS By crosslinking data from Danish nationwide registries, we identified patients with a first-time digital LBBB ECG between 2001 and 2015. The vectorcardiographic QRS area was derived from a 12‑lead ECG using the Kors transformation method and grouped into quartiles. The endpoint was a composite of HF diagnosis, filled prescriptions for loop diuretics, or death from HF. Cause-specific multivariable Cox regression was used to compute hazard ratios(HR) with 95% confidence intervals(CI). RESULTS We included 3316 patients with LBBB free from prior HF-related events (median age, 72 years; male, 40%). QRS area quartiles comprised Q1, 36-98 μVs; Q2, 99-119 μVs; Q3, 120-145 μVs; and Q4, 146-295 μVs. During a 5-year follow-up, 31% of patients reached the composite endpoint, with a rate of 39% in the highest quartile Q4. A QRS area in quartile Q4 was associated with increased hazard of the composite endpoint (HR:1.48, 95%CI:1.22-1.80) compared with Q1. CONCLUSIONS Among primary care patients with newly discovered LBBB, a large vectorcardiographic QRS area (146-295 μVs) was associated with an increased risk of incident HF diagnosis, filling prescriptions for loop diuretics, or dying from HF within 5-years.
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Affiliation(s)
| | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Peter L Sørensen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jonas Bille Nielsen
- Laboratory for Molecular Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Adrian Pietersen
- Copenhagen General Practitioners' Laboratory, Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Brett D Atwater
- Inova Heart and Vascular Institute, Fairfax, VA, United States
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology, Yale School of Medicine, New Haven, CT, United States
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Christoffer Polcwiartek
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Inova Heart and Vascular Institute, Fairfax, VA, United States
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15
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Salatzki J, Fischer T, Riffel J, André F, Hirschberg K, Ochs A, Hund H, Müller-Hennessen M, Giannitsis E, Friedrich MG, Scholz E, Frey N, Katus HA, Ochs M. Presence of contractile impairment appears crucial for structural remodeling in idiopathic left bundle-branch block. J Cardiovasc Magn Reson 2021; 23:39. [PMID: 33789682 PMCID: PMC8015193 DOI: 10.1186/s12968-021-00731-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 02/08/2021] [Indexed: 11/10/2022] Open
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.
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Affiliation(s)
- Janek Salatzki
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany.
| | - Theresa Fischer
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Kristóf Hirschberg
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Matthias Müller-Hennessen
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Matthias G Friedrich
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
- Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, Canada
| | - Eberhard Scholz
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
| | - Marco Ochs
- Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany
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16
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Ko HC, Cho YH, Jang W, Kim SH, Lee HS, Ko WH. Transient left bundle branch block after posture change to the prone position during general anesthesia: A case report. Medicine (Baltimore) 2021; 100:e25190. [PMID: 33726011 PMCID: PMC7982238 DOI: 10.1097/md.0000000000025190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The prone position is commonly used in spinal surgery. There have been many studies on hemodynamic changes in the prone position during general anesthesia. We report a rare case of transient left bundle branch block (LBBB) in a prone position. PATIENT CONCERN Electrocardiogram (ECG) of a 64-year-old man scheduled for spinal surgery showed normal sinus rhythm change to LBBB after posture change to the prone position. DIAGNOSIS Twelve lead ECG revealed LBBB. His coronary angio-computed tomography results showed right coronary artery with 30% to 40% stenosis and left circumflex artery with 40% to 50% stenosis. The patient was diagnosed with stable angina and second-degree atrioventricular block of Mobitz type II. INTERVENTION Nitroglycerin was administered intravenously during surgery. Adequate oxygen was supplied to the patient. After surgery, the patient was prescribed clopidogrel, statins, angiotensin II receptor blocker, and a permanent pacemaker was inserted. OUTCOME Surgery was completed without complications. After surgery, the transient LBBB changed to a normal sinus rhythm. The patient did not complain of chest pain or dyspnea. LESSON The prone position causes significant hemodynamic changes. A high risk of cardiovascular disease may cause ischemic heart disease and ECG changes. Therefore, careful management is necessary.
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17
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Delise P, Rivetti L, Poletti G, Centa M, Allocca G, Sitta N, Cati A, Turiano G, Lanari E, Zeppilli P, Sciarra L. Clinical and Prognostic Significance of Idiopathic Left Bundle-Branch Block in Young Adults. Cardiol Res Pract 2021; 2021:6677806. [PMID: 33777448 PMCID: PMC7969112 DOI: 10.1155/2021/6677806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS LBBB is rare in healthy young adults, and its long-term prognosis is uncertain. METHODS 56 subjects (aged <50 years), in whom an LBBB was discovered by chance in the absence of clinical and echocardiographic evidence of heart disease, were collected in a multicenter registry. RESULTS 69% were males. Mean age at the time of discovery of LBBB was 37 ± 11 years. Mean QRS duration was 149 ± 17 m sec and 35% had left axis deviation. All patients had a normal echocardiogram, except for left ventricular dyssynchrony; 37 patients underwent coronary angiography (30) or myocardial scintigraphy during effort Eriksson and Wilhelmsen (2005), and in all cases obstructive coronary artery disease was excluded. In 2/30 patients who underwent coronary angiography, an anomalous origin of the CX artery from the right coronary sinus was found. Thirty patients underwent cardiac magnetic resonance; in 60% it was normal, while in 40% it revealed late enhancement, which in 33% was localized in the basal septum, suggesting fibrosis of the left bundle branch. During follow-up (12+/10 years, median 10 years) no sudden death occurred. At the end of follow-up, all patients were alive, except for one who suffered accidental death. Two patients (3.5%) underwent PM implantation owing to syncope. The echocardiogram at the end of follow-up revealed LV dysfunction in only one patient. CONCLUSIONS In young adults without apparent heart disease, LBBB is a heterogeneous condition. In the vast majority of cases, the prognosis is good and no ventricular dysfunction occurs over time. However, as only 18% of our patients were aged >60 years at the end of follow-up, we cannot establish the prognosis in older age-groups.
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Affiliation(s)
- Pietro Delise
- Division of Cardiology, P. Pederzoli Hospital, Peschiera Del Garda, Italy
| | - Luigi Rivetti
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
| | | | - Monica Centa
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
| | - Giuseppe Allocca
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
| | - Nadir Sitta
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
| | - Arianna Cati
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
| | - Giovanni Turiano
- Division of Cardiology, Hospital of S. Donà di Piave, S. Donà di Piave, Italy
| | - Emanuela Lanari
- Division of Cardiology, Conegliano Hospital, Conegliano, TV, Italy
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18
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Aimo A, Valleggi A, Barison A, Salerni S, Emdin M, Aquaro GD. 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. Int J Cardiovasc Imaging 2021; 37:2245-2255. [PMID: 33635416 PMCID: PMC8286944 DOI: 10.1007/s10554-021-02194-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/13/2021] [Indexed: 12/15/2022]
Abstract
Patients 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.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy.
- Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, 56124, Pisa, Italy.
| | - Alessandro Valleggi
- Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Andrea Barison
- Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
| | - Giovanni Donato Aquaro
- Fondazione Toscana Gabriele Monasterio, Piazza Martiri della Libertà 33, 56124, Pisa, Italy
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Søndergaard MM, Riis J, Bodker KW, Hansen SM, Nielsen J, Graff C, Pietersen AH, Nielsen JB, Tayal B, Polcwiartek C, Torp-Pedersen C, Soegaard P, Kragholm KH. Associations between left bundle branch block with different PR intervals, QRS durations, heart rates and the risk of heart failure: a register-based cohort study using ECG data from the primary care setting. Open Heart 2021; 8:e001425. [PMID: 33574021 PMCID: PMC7880100 DOI: 10.1136/openhrt-2020-001425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
AIM Left bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data. METHODS AND RESULTS Using ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis.Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p<0.001). There was no association between the PR interval and HF after adjustment. CONCLUSION Prolonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.
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Affiliation(s)
| | - Johannes Riis
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Steen Møller Hansen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jesper Nielsen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health, Science and Technology, Aalborg University Faculty of Health Sciences, Aalborg, Denmark
| | - Adrian Holger Pietersen
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerod, Denmark
| | - Jonas Bille Nielsen
- University of Copenhagen, Danish National Research Foundation Centre for Cardiac Arrhythmia (DARC), Copenhagen, Denmark
- Department of Cardiology, Laboratory of Molecular Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Hospital Vendsyssel in Hjørring, Hjorring, Denmark
| | - Christoffer Polcwiartek
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | | | - Peter Soegaard
- Cardiology Clinic Heart-Lung, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Hay Kragholm
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, Regional Hospital North Jutland, Hjorring, Denmark
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Beaty B, Park D. Diagnosis of Myocardial Infarction in a Patient with Left Bundle Branch Block and Negative Sgarbossa Criteria. J Osteopath Med 2020; 120:2765209. [PMID: 32750705 DOI: 10.7556/jaoa.2020.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Left bundle branch block complicates electrocardiogram interpretation of acute myocardial infarction (MI) because ST segment elevations, commonly used as evidence of MIs, are largely hidden by the repolarization vector. To better diagnose acute MI in cases of left bundle branch block, modified Sgarbossa criteria can be used as a clinical tool to help diagnose or exclude MI with high specificity and sensitivity. However, while clinical tools are often helpful, a clinician cannot solely rely on clinical decision-making algorithms. We describe the case of an 84-year-old man experiencing acute cardiopulmonary symptoms who was negative for modified Sgarbossa criteria, but later had a confirmed diagnosis of MI on transfer to a cardiac center. This case illustrates the necessity of good clinical judgment and a high index of suspicion for atypical presentation alongside any diagnostic algorithm.
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21
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Huang HC, Wang J, Liu YB, Chien KL. Clinical Outcomes of Complete Left Bundle Branch Block According to Strict or Conventional Definition Criteria in Patients with Normal Left Ventricular Function. ACTA CARDIOLOGICA SINICA 2020; 36:335-342. [PMID: 32675925 PMCID: PMC7355119 DOI: 10.6515/acs.202007_36(4).20191230a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Complete left bundle branch block (cLBBB) is associated with poor outcomes in patients with heart failure (HF) but appears to have minimal effects on cardiovascular (CV) mortality in relatively healthy adults. New criteria to define strict cLBBB have been proposed. OBJECTIVES The aim of this study was to stratify the potential risk of cLBBB according to conventional or strict criteria in patients with normal ejection fraction (EF). METHODS Patients with cLBBB from 2010 to 2013 who underwent baseline echocardiography within 1 year and had a left ventricular ejection fraction (LVEF) > 50% were enrolled. A control group of patients without intraventricular conduction abnormalities matched for age and sex was included. Primary outcomes including CV mortality, HF admission, EF reduction of 40%, and total mortality were compared. RESULTS A total of 137 patients with cLBBB were included, of whom 118 had strict cLBBB. The mean age was 72 ± 15 years and 56.2% were men. With a median follow-up of 4.3 years, normal LVEF patients with cLBBB but without a history of atrial fibrillation had a significantly higher risk of CV mortality (p < 0.001), EF reduction to 40% (p < 0.001), and admission for HF (p < 0.001). A similar risk of CV events was noted for the patients with conventional and strict cLBBB. CONCLUSIONS In patients with normal EF and without a history of atrial fibrillation, the presence of cLBBB led to a greater risk of CV mortality, HF admission and EF reduction to < 40%. Strict cLBBB carries a similar risk of CV events to conventional cLBBB.
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Affiliation(s)
- Hui-Chun Huang
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Jui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Bin Liu
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Kuo-Liong Chien
- Department of Internal Medicine, Division of Cardiology, National Taiwan University Hospital and National Taiwan University College of Medicine;
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Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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22
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Zegard A, Okafor O, de Bono J, Steeds R, Hudsmith L, Stegemann B, Jani A, Marshall H, Holloway B, Leyva F. Prognosis of incidental left bundle branch block. Europace 2020; 22:956-963. [PMID: 32285097 DOI: 10.1093/europace/euaa008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/09/2020] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Abbasin Zegard
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Osita Okafor
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Joseph de Bono
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Richard Steeds
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Lucy Hudsmith
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Berthold Stegemann
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
| | - Ayman Jani
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Howard Marshall
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Ben Holloway
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Francisco Leyva
- Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK
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23
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Natural history and clinical significance of isolated complete left bundle branch block without associated structural heart disease. Anatol J Cardiol 2020; 25:170-176. [PMID: 33690131 DOI: 10.14744/anatoljcardiol.2020.10008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Left bundle branch block (LBBB), which is associated with underlying cardiac disease, is believed to play a role in the pathogenesis of cardiomyopathy through delays in interventricular conduction, leading to dyssynchrony. However, this has not been established in previous studies. It is unclear whether LBBB indicates clinically advanced cardiac disease or is an independent factor responsible for increased mortality and the development of heart failure. We investigated the natural history of isolated LBBB without any associated structural heart disease in order to determine its clinical significance. METHODS We performed a retrospective chart review on consecutive patients who fulfilled the 12-lead electrocardiographic (ECG) criteria for complete LBBB and had a normal echocardiogram with no evidence of structural heart disease and left or right ventricular systolic dysfunction within three months of the initial ECG between January 1, 2000 and December 31, 2009. We excluded patients with documented coronary artery disease (CAD) at any time, any structural heart disease, or cardiac devices. We evaluated the primary endpoints of mortality and incidence of cardiomyopathy, as well as any heart failure hospitalizations over a 1- and 10-year period. RESULTS We identified 2522 eligible patients. The mean follow-up duration was 8.4±3.2 years. The one-year mortality rate was 7.8%, with a 10-year mortality rate of 22.0%. The incidence of cardiomyopathy over one year was 3.2% and over 10 years was 9.1%. There was no significant difference in QRS duration between patients who were alive and those that were deceased at 10 years (141+/-18 vs. 141+/-17 ms; p=0.951) and patients with and without cardiomyopathy at 10 years (142±17 vs. 141±17 ms; p=0.532). CONCLUSION Isolated LBBB occurring without structural heart disease, ventricular dysfunction, or CAD is associated with a low mortality rate and incidence of cardiomyopathy.
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Wang H, Chu YQ, Yu XY, Chen R, Xing YL, Yu XX, Wang C, Sun L, Xu YM, Li XM, Cui XZ. Correlation Between Arrhythmia and the Prognosis in Children With EFE/LVNC/DCM. Front Pediatr 2020; 8:280. [PMID: 32587842 PMCID: PMC7297920 DOI: 10.3389/fped.2020.00280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/04/2020] [Indexed: 01/09/2023] Open
Abstract
Aim: To explore the correlation between different phenotypes of arrhythmia and the prognosis in children with EFE/LVNC/DCM. Methods: A total of 167 children with cardiomyopathy diagnosed and treated in Shengjing Hospital between January 2010 and May 2019 were evaluated. After patient screening, 31 patients with endomyocardial fibroelastosis (EFE), left ventricular non-compaction, or dilated cardiomyopathy with significant arrhythmias were selected. In addition, 42 children with primary EFE were selected to evaluate the prognosis with or without arrhythmia. Follow-up was undertaken 0, 1, 3, 6, 9, and 12 months after treatment. Results: We revealed the outcomes for five types of cardiomyopathy: EFE patients with Wolff-Parkinson-White syndrome B and supraventricular tachycardia, intraventricular block and complete left bundle branch block recovered slower than EFE patients with atrial flutter and atrial fibrillation, even slower than EFE with ventricular tachycardia. The average recovering time for LVEF and LVED in EFE patients without arrythmia was 10 months after diagnosis, while 76.9% (3/13 cases) of those with significant arrythmia hadn't recovered until 24 months after diagnosis. Three of patients died at 6, 7, and 6 and half years after diagnosis. Conclusion: The long-term prognosis in children with cardiomyopathy is associated with the type of arrhythmia and time of intervention. The prognosis of EFE patients with arrhythmia is worse than EFE patients without arrhythmia. Patients with Wolff-Parkinson-White syndrome B, especially a significantly widen QRS complex, carry a poor prognosis if radiofrequency ablation is not undertaken. CLBBB patients have similar poor prognosis if proper pacemaker is not implanted timely.
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Affiliation(s)
- Hong Wang
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yan-Qiu Chu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xian-Yi Yu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Rui Chen
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yan-Lin Xing
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xue-Xin Yu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Ce Wang
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yun-Ming Xu
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xue-Mei Li
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xiao-Zhe Cui
- Department of Pediatrics, Shengjing Hospital, China Medical University, Shenyang, China
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25
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Ludhwani D, Rahaby M, Patel V, Jamil S, Kedzia A, Wu C. Implications of Left Bundle Branch Block in Takotsubo Cardiomyopathy: Propensity Match Analysis from the National Inpatient Sample. Cardiol Ther 2019; 8:253-265. [PMID: 31317468 PMCID: PMC6828991 DOI: 10.1007/s40119-019-0141-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TTC), also called stress cardiomyopathy, is a transient reversible left ventricular dysfunction mimicking acute coronary syndrome (ACS). Studies have shown similar rates of in-hospital complications in TTC and myocardial infarction (MI). Left bundle branch block (LBBB) is associated with increased mortality in patients with MI; however, similar studies comparing outcomes of TTC in the presence of LBBB are lacking. METHODS The 2016 National Inpatient Sample (NIS) database was queried to identify all admissions with a primary discharge diagnosis of TTC. Diagnosis-specific codes were used to stratify patients based on the presence or absence of LBBB. Both population sets were paired using 1:10 propensity score matching. Multivariate logistic regression analysis was performed to compare various in-hospital outcomes among both groups. RESULTS Amongst 7270 admissions for TTC, 226 patients had concomitant LBBB. After performing 1:10 propensity matching, 130 patients with LBBB were compared to 1275 patients without LBBB. The presence of LBBB was associated with increased odds of cardiogenic shock (AOR = 2.2, 95% CI 1.21-3.99, p = 0.0097); ventricular arrhythmia (AOR 1.99, 95% CI 1.11-3.57, p = 0.02), acute congestive heart failure (AOR = 1.49, 95% CI 1.01-2.2, p = 0.04), and sudden cardiac arrest (AOR = 3.37, 95% CI 1.59-7.13, p = 0.0001). There was no statistical difference in all-cause in-hospital mortality, however a trend towards worsening was noted. CONCLUSIONS The incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.
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Affiliation(s)
- Dipesh Ludhwani
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA.
| | - Mouyyad Rahaby
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA
| | - Vasu Patel
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA
| | - Saad Jamil
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA
| | - Adam Kedzia
- Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA
| | - Chunyi Wu
- University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA
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Salah M, Gevaert S, Coussement P, Beauloye C, Sinnaeve PR, Convens C, De Raedt H, Dens J, Pourbaix S, Saenen J, Claeys MJ. Vulnerability to cardiac arrest in patients with ST elevation myocardial infarction: Is it time or patient dependent? Results from a nationwide observational study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:S153-S160. [PMID: 31452398 DOI: 10.1177/2048872619872127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM Cardiac arrest is a common complication of ST elevation myocardial infarction and is associated with high mortality. We evaluated whether vulnerability to cardiac arrest follows a circadian rhythm and whether it is related to specific patient characteristics. METHODS A total of 24,164 ST elevation myocardial infarction patients who were admitted to 60 Belgian hospitals between 2008-2017 were analysed. The proportion of patients with cardiac arrest before initiation of reperfusion therapy was calculated for different time periods (hour of the day, months, seasons) and related to patient characteristics using stepwise logistic regression analysis. RESULTS Cardiac arrest occurred in 10.8% of the ST elevation myocardial infarction patients at a median of 65 min (interquartile range 33-138 min) after onset of pain. ST elevation myocardial infarction patients with cardiac arrest showed a biphasic pattern with one peak in the morning and one peak in the late afternoon. Multivariate analysis identified the following independent factors associated with cardiac arrest: cardiogenic shock (odds ratio=28), left bundle branch block (odds ratio=3.7), short (<180 min) ischaemic period (odds ratio=2.2), post-meridiem daytime presentation (odds ratio=1.4), anterior infarction (odds ratio=1.3). Overall in-hospital mortality was 30% for cardiac arrest patients versus 3.7% for non-cardiac arrest patients (p<0.0001). CONCLUSION In the present study population, cardiac arrest in ST elevation myocardial infarction showed an atypical circadian rhythm with not only a morning peak but also a second peak in the late afternoon, suggesting that cardiac arrest and ST elevation myocardial infarction triggers are, at least partially, different. In addition, specific patient characteristics, such as short ischaemic period, cardiogenic shock and left bundle branch block, increase the vulnerability to cardiac arrest.
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Affiliation(s)
- Mahadi Salah
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Belgium
| | | | | | | | - Carl Convens
- Department of Cardiology, ZNA Antwerpen, Belgium
| | | | - Jo Dens
- Department of Cardiology, ZOL Genk, Belgium
| | | | - Johan Saenen
- Department of Cardiology, University Hospital Antwerp, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Belgium
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Sanna GD, Merlo M, Moccia E, Fabris E, Masia SL, Finocchiaro G, Parodi G, Sinagra G. Left bundle branch block-induced cardiomyopathy: a diagnostic proposal for a poorly explored pathological entity. Int J Cardiol 2019; 299:199-205. [PMID: 31186131 DOI: 10.1016/j.ijcard.2019.06.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/06/2019] [Accepted: 06/03/2019] [Indexed: 12/21/2022]
Abstract
Despite being increasingly recognized as a specific disease, at the present time left bundle branch block (LBBB)-induced cardiomyopathy is neither formally included among unclassified cardiomyopathies nor among the acquired/non-genetic forms of dilated cardiomyopathy (DCM). Currently, a post-hoc diagnosis of LBBB-induced cardiomyopathy is possible when evaluating patients' response to cardiac resynchronization therapy (CRT). However, an early detection of a LBBB-induced cardiomyopathy could have significant clinical and therapeutic implications. Patients with the aforementioned form of dyssynchronopathy may benefit from early CRT and overall prognosis might be better as compared to patients with a primary muscle cell disorder (i.e. "true" DCM). The real underlying mechanisms, the possible genetic background as well as the early identification of this specific form of DCM remain largely unknown. In this review the complex relationship between LBBB and left ventricular non-ischaemic dysfunction is described. Furthermore, a multiparametric approach based on clinical, electrocardiographic and imaging red flags, is provided in order to allow an early detection of the LBBB-induced cardiomyopathy.
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Affiliation(s)
- Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy.
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy
| | - Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Enrico Fabris
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy
| | | | | | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste "ASUITS", Trieste, Italy.
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Moccia E, Sanna GD, Parodi G. Transient left bundle branch block and intraventricular dyssynchrony as a cause of reversible left ventricular dysfunction: The "in vivo" documentation of spontaneous electrical remodeling. Ann Noninvasive Electrocardiol 2019; 24:e12667. [PMID: 31141243 DOI: 10.1111/anec.12667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 11/30/2022] Open
Abstract
Spontaneous resolution of non-rate-dependent left bundle branch block (LBBB) has been rarely reported. We present the case of a 74-year-old woman admitted with pulmonary edema, a newly diagnosed LBBB and severe left ventricular (LV) dysfunction. Five months later, the patient was asymptomatic, the ECG recording showed complete regression of the LBBB to narrow QRS and LV function completely recovered. However, at one-year follow-up LBBB reappeared together with mild LV dysfunction. Spontaneous resolution of LBBB may be responsible for LV electrical and mechanical reverse remodeling in dyssynchronopathies.
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Affiliation(s)
- Eleonora Moccia
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Giuseppe D Sanna
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Guido Parodi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
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Axelsson J, Wieslander B, Jablonowski R, Klem I, Nijveldt R, Schelbert EB, Sörensson P, Sigfridsson A, Chaudhry U, Platonov PG, Borgquist R, Engblom H, Strauss DG, Arheden H, Atwater BD, Ugander M. Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar. J Electrocardiol 2018; 51:1071-1076. [PMID: 30497733 DOI: 10.1016/j.jelectrocard.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/09/2018] [Accepted: 09/15/2018] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The relationship between left ventricular (LV) ejection fraction (EF) and LV myocardial scar can identify potentially reversible causes of LV dysfunction. Left bundle branch block (LBBB) alters the electrical and mechanical activation of the LV. We hypothesized that the relationship between LVEF and scar extent is different in LBBB compared to controls. METHODS We compared the relationship between LVEF and scar burden between patients with LBBB and scar (n = 83), and patients with chronic ischemic heart disease and scar but no electrocardiographic conduction abnormality (controls, n = 90), who had undergone cardiovascular magnetic resonance (CMR) imaging at one of three centers. LVEF (%) was measured in CMR cine images. Scar burden was quantified by CMR late gadolinium enhancement (LGE) and expressed as % of LV mass (%LVM). Maximum possible LVEF (LVEFmax) was defined as the function describing the hypotenuse in the LVEF versus myocardial scar extent scatter plot. Dysfunction index was defined as LVEFmax derived from the control cohort minus the measured LVEF. RESULTS Compared to controls with scar, LBBB with scar had a lower LVEF (median [interquartile range] 27 [19-38] vs 36 [25-50] %, p < 0.001), smaller scar (4 [1-9] vs 11 [6-20] %LVM, p < 0.001), and greater dysfunction index (39 [30-52] vs 21 [12-35] % points, p < 0.001). CONCLUSIONS Among LBBB patients referred for CMR, LVEF is disproportionately reduced in relation to the amount of scar. Dyssynchrony in LBBB may thus impair compensation for loss of contractile myocardium.
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Affiliation(s)
- Jimmy Axelsson
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wieslander
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Robert Jablonowski
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Igor Klem
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Peder Sörensson
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Uzma Chaudhry
- Arrhythmia Clinic, Skåne University Hospital, Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Pyotr G Platonov
- Arrhythmia Clinic, Skåne University Hospital, Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital, Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - David G Strauss
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden; US Food and Drug Administration, Silver Spring, MD, USA
| | - Håkan Arheden
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Brett D Atwater
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
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Idiopathic/Iatrogenic Left Bundle Branch Block–Induced Reversible Left Ventricle Dysfunction. J Am Coll Cardiol 2018; 72:3177-3188. [DOI: 10.1016/j.jacc.2018.09.069] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 11/17/2022]
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Jensen JR, Kragholm K, Bødker KW, Mortensen R, Graff C, Pietersen A, Nielsen JB, Polcwiartek C, Tayal B, Torp-Pedersen C, Søgaard P, Hansen SM. Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study. J Electrocardiol 2018; 52:39-45. [PMID: 30476637 DOI: 10.1016/j.jelectrocard.2018.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. METHODS Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. RESULTS In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. CONCLUSION T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.
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Affiliation(s)
- Johannes Riis Jensen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
| | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Rikke Mortensen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Adrian Pietersen
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | | | - Christoffer Polcwiartek
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bhupendar Tayal
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hilleroed, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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Fischer Q, Himbert D, Webb JG, Eltchaninoff H, Muñoz-García AJ, Tamburino C, Nombela-Franco L, Nietlispach F, Moris C, Ruel M, Dager AE, Serra V, Cheema AN, Amat-Santos IJ, de Brito FS, Ribeiro H, Abizaid A, Sarmento-Leite R, Dumont E, Barbanti M, Durand E, Alonso Briales JH, Bouleti C, Immè S, Maisano F, del Valle R, Miguel Benitez L, García del Blanco B, Côté M, Philippon F, Urena M, Rodés-Cabau J. Impact of Preexisting Left Bundle Branch Block in Transcatheter Aortic Valve Replacement Recipients. Circ Cardiovasc Interv 2018; 11:e006927. [DOI: 10.1161/circinterventions.118.006927] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Quentin Fischer
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - Dominique Himbert
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - John G. Webb
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia Canada (J.G.W., M.B
| | - Helene Eltchaninoff
- Department of Cardiology, Hopital Charles Nicolle, University of Rouen, France (H.E., E.D.)
| | - Antonio J. Muñoz-García
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Universidad de Malaga, Spain (A.J.M.-G., J.H.A.B.)
| | - Corrado Tamburino
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain (L.N.-F.)
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center, Transcatheter Valve Clinic, Zurich, Switzerland (F.N., F.M.)
| | - Cesar Moris
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.M., R.d.V.)
| | - Marc Ruel
- Department of Cardiology, Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R.)
| | - Antonio E. Dager
- Department of Cardiology, Clinica de Occidente de Cali, Colombia (A.E.D., L.M.B.)
| | - Vicenç Serra
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Asim N. Cheema
- Department of Cardiology, St. Michael’s Hospital, Toronto University, Ontario, Canada (A.N.C.)
| | - Ignacio J. Amat-Santos
- Department of Cardiology, Hospital Clinico Universitario de Valladolid, Spain (I.J.A.-S.)
| | - Fabio Sandoli de Brito
- Department of Cardiology, Hospital Israelita Albert Einstein, Sa.o Paulo, Brazil (F.S.d.B)
| | - Henrique Ribeiro
- Department of Cardiology, Heart Institute-InCor, University of Sa.o Paulo, Brazil (H.R.)
| | - Alexandre Abizaid
- Department of Cardiology, Instituto Dante Pazzanese de Cardiologia, Sa.o Paulo, Brazil (A.A.)
| | - Rogério Sarmento-Leite
- Department of Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil (R.S.-L.)
| | - Eric Dumont
- Department of Cardiology, Hopital Charles Nicolle, University of Rouen, France (H.E., E.D.)
| | - Marco Barbanti
- Department of Cardiology, St. Paul’s Hospital, Vancouver, British Columbia Canada (J.G.W., M.B
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | | | - Juan H. Alonso Briales
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Universidad de Malaga, Spain (A.J.M.-G., J.H.A.B.)
| | - Claire Bouleti
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - Sebastiano Immè
- Department of Cardiology, Ferrarotto Hospital, University of Catania, Italy (C.T., M.B., S.I.)
| | - Francesco Maisano
- Department of Cardiology, University Heart Center, Transcatheter Valve Clinic, Zurich, Switzerland (F.N., F.M.)
| | - Raquel del Valle
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain (C.M., R.d.V.)
| | - Luis Miguel Benitez
- Department of Cardiology, Clinica de Occidente de Cali, Colombia (A.E.D., L.M.B.)
| | - Bruno García del Blanco
- Department of Cardiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Mélanie Côté
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - François Philippon
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
| | - Marina Urena
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, France (D.H., C.B., M.U.)
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Canada (Q.F., E.D., M.C., F.P., J.R.-C.)
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Akhtari S, Chuang ML, Salton CJ, Berg S, Kissinger KV, Goddu B, O’Donnell CJ, Manning WJ. Effect of isolated left bundle-branch block on biventricular volumes and ejection fraction: a cardiovascular magnetic resonance assessment. J Cardiovasc Magn Reson 2018; 20:66. [PMID: 30231875 PMCID: PMC6146610 DOI: 10.1186/s12968-018-0457-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/08/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Left bundle branch block (LBBB) is associated with abnormal left ventricular (LV) contraction, and is frequently associated with co-morbid cardiovascular disease, but the effect of an isolated (i.e. in the absence of cardiovascular dissease) LBBB on biventricular volumes and ejection fraction (EF) is not well characterized. The objective of this study was to compare LV and right ventricular (RV) volumes and EF in adults with an isolated LBBB to matched healthy controls and to population-derived normative values, using cardiovascular magnetic resonance (CMR) imaging. METHODS We reviewed our clinical echocardiography database and the Framingham Heart Study Offspring cohort CMR database to identify adults with an isolated LBBB. Age-, sex-, hypertension-status, and body-surface area (BSA)-matched controls were identified from the Offspring cohort. All study subjects were scanned using the same CMR hardware and imaging sequence. Isolated-LBBB cases were compared with matched controls using Wilcoxon paired signed-rank test, and to normative reference values via Z-score. RESULTS Isolated-LBBB subjects (n = 18, 10F) ranged in age from 37 to 82 years. An isolated LBBB was associated with larger LV end-diastolic and end-systolic volumes (both p < 0.01) and lower LVEF (56+/- 7% vs. 68+/- 6%; p <0.001) with similar myocardial contraction fraction. LVEF in isolated LBBB was nearly two standard deviations (Z = - 1.95) below mean sex and age-matched group values. LV stroke volume, cardiac output, and mass, and all RV parameters were similar (p = NS) between the groups. CONCLUSIONS Adults with an isolated LBBB have greater LV volumes and markedly reduced LVEF, despite the absence of overt cardiovascular disease. These data may be useful toward the clinical interpretation of imaging studies performed on patients with an isolated LBBB.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Bundle-Branch Block/complications
- Bundle-Branch Block/diagnostic imaging
- Bundle-Branch Block/physiopathology
- Case-Control Studies
- Databases, Factual
- Female
- Humans
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Myocardial Contraction
- Predictive Value of Tests
- Stroke Volume
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
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Affiliation(s)
- Shadi Akhtari
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Michael L. Chuang
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
- The NHLBI’s Framingham Heart Study, Framingham, MA USA
| | - Carol J. Salton
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Sophie Berg
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Kraig V. Kissinger
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Beth Goddu
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
| | - Christopher J. O’Donnell
- The NHLBI’s Framingham Heart Study, Framingham, MA USA
- Cardiology Section, Veterans Affairs Healthcare System, Boston, MA USA
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215 USA
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
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Mangieri A, Montalto C, Pagnesi M, Lanzillo G, Demir O, Testa L, Colombo A, Latib A. TAVI and Post Procedural Cardiac Conduction Abnormalities. Front Cardiovasc Med 2018; 5:85. [PMID: 30018969 PMCID: PMC6038729 DOI: 10.3389/fcvm.2018.00085] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 06/12/2018] [Indexed: 01/20/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a worldwide accepted alternative for treating patients at intermediate or high risk for surgery. In recent years, the rate of complications has markedly decreased except for new-onset atrioventricular and intraventricular conduction block that remains the most common complication after TAVI. Although procedural, clinical, and electrocardiographic predisposing factors have been identified as predictors of conduction disturbances, new strategies are needed to avoid such complications, particularly in the current TAVI era that is moving quickly toward the percutaneous treatment of low-risk patients. In this article, we will review the incidence, predictive factors, and clinical implications of conduction disturbances after TAVI.
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Affiliation(s)
| | | | | | | | - Ozan Demir
- IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Azeem Latib
- IRCCS San Raffaele Scientific Institute, Milan, Italy
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35
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Prognostic Significance and Clinical Utility of Intraventricular Conduction Delays on the Preoperative Electrocardiogram. Am J Cardiol 2018; 121:997-1003. [PMID: 29499923 DOI: 10.1016/j.amjcard.2018.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/24/2017] [Accepted: 01/08/2018] [Indexed: 11/24/2022]
Abstract
The prognostic significance of the preoperative electrocardiogram (ECG), particularly intraventricular conduction delays (IVCDs), on postoperative outcomes among patients undergoing noncardiac surgery is uncertain. In a retrospective cohort, we evaluated the risk associated with preoperative IVCDs on in-hospital death and postoperative myocardial infarction (POMI). The 152,479 patients who underwent noncardiac surgery were categorized by preoperative electrocardiographic findings: normal (36.1%), left bundle branch block (LBBB, 1.2%), right bundle branch block (2.9%), nonspecific IVCD (3.3%), and any other ECG abnormality (56.5%). The primary and secondary outcomes were postoperative in-hospital mortality and POMI, respectively. In multivariable-adjusted models, compared with normal ECGs, each electrocardiographic abnormality category was associated with increased risk of postoperative death: LBBB odds ratio (OR) 1.89 (95% confidence interval [CI] 1.35 to 2.65), right bundle branch block OR 1.73 (95% CI 1.33 to 2.24), nonspecific IVCD OR 1.95 (95% CI 1.53 to 2.48), and other abnormal ECG OR 1.94 (95% CI 1.68 to 2.25). ECGs with conduction delays did not confer increased risk of postoperative death compared with other ECG abnormalities. Moreover, receiver operating characteristic analysis of models incorporating demographic and co-morbidity data demonstrated marginal additive benefit of any electrocardiographic data. Risk of POMI was not significantly increased among ECGs with conduction delays compared with both normal and other abnormal ECGs. In conclusion, patients with intraventricular conduction disease, including LBBB, on preoperative ECG are not at greater risk of postoperative in-hospital death or POMI compared with patients with other ECG abnormalities. Furthermore, any preoperative electrocardiographic abnormalities, including intraventricular delays, provide marginal clinical utility beyond demographic and clinical history for predicting postoperative in-hospital death or POMI.
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36
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Kanawati J, Sy RW. Contemporary Review of Left Bundle Branch Block in the Failing Heart - Pathogenesis, Prognosis, and Therapy. Heart Lung Circ 2017; 27:291-300. [PMID: 29097067 DOI: 10.1016/j.hlc.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/13/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
Cardiac resynchronisation therapy (CRT) is a cornerstone in the contemporary management of heart failure. The most effective way of predicting response to this therapy remains electrocardiographic (ECG) criteria of electromechanical dyssynchrony. The left bundle branch block (LBBB) pattern is currently the most robust ECG criterion in predicting improvement in symptoms and reduction in mortality. However, recent studies using three-dimensional (3D) mapping and cardiac magnetic resonance imaging (CMR) have demonstrated heterogeneous left ventricular activation patterns in patients with LBBB. This has led to intense debate on the activation pattern of "true LBBB" and resulted in the proposal of stricter criteria for defining LBBB. This review will focus on the definitions and implications of LBBB in the CRT era. At a minimum, the use of stricter ECG criteria appears warranted, and adjunctive pre-implant imaging or mapping may further identify patient-specific electrophysiological patterns that determine response to CRT.
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Affiliation(s)
- Juliana Kanawati
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Department of Cardiology, Concord Repatriation General Hospital, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Grand J, Thomsen JH, Kjaergaard J, Nielsen N, Erlinge D, Wiberg S, Wanscher M, Bro-Jeppesen J, Hassager C. Prevalence and Prognostic Implications of Bundle Branch Block in Comatose Survivors of Out-of-Hospital Cardiac Arrest. Am J Cardiol 2016; 118:1194-1200. [PMID: 27553102 DOI: 10.1016/j.amjcard.2016.07.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 11/29/2022]
Abstract
This study reports the prevalence and prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in the admission electrocardiogram (ECG) of comatose survivors of out-of-hospital cardiac arrest (OHCA). The present study is part of the predefined electrocardiographic substudy of the prospective randomized target temperature management trial, which found no benefit of targeting 33°C over 36°C in terms of outcome. Six-hundred eighty-two patients were included in the substudy. An admission ECG, which defined the present study population, was available in 602 patients (88%). These ECGs were stratified by the presence of LBBB, RBBB, or no-BBB (reference) on admission. End points were mortality and neurologic outcome 6 months after OHCA. RBBB was present in 79 patients (13%) and LBBB in 65 patients (11%), and the majority of BBBs (92%) had resolved 4 hours after admission. RBBB was associated with significantly higher 6 months mortality (RBBB: hazard ratio [HR]unadjusted 1.78, 95% confidence interval [CI] 1.30 to 2.43; LBBB: HRunadjusted 1.26, 95% CI 0.87 to 1.81), but this did not reach a level of significance in the adjusted model (HRadjusted 1.33, 95% CI 0.94 to 1.87). Similar findings were seen for neurologic outcome in the unadjusted and adjusted analyses. RBBB was further independently associated with higher odds of unfavorable neurologic outcome (RBBB: adjusted odds ratio 1.97, 95% CI 1.05 to 3.71). In conclusion, BBBs after OHCA were transient in most patients, and RBBB was directly associated with higher mortality and independently associated with higher odds of unfavorable neurologic outcome. RBBB is seemingly an early indicator of an unfavorable prognosis after OHCA.
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Affiliation(s)
- Johannes Grand
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Jesper Kjaergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Niklas Nielsen
- Department of Anesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University Hospital, Lund, Sweden
| | - Sebastian Wiberg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Michael Wanscher
- Department of Cardiothoracic Anesthesia, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - John Bro-Jeppesen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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38
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Mair L, Warriner D, Payne G. Assessment of an incidental finding of left bundle-branch block. Br J Hosp Med (Lond) 2015; 76:196-9. [PMID: 25853348 DOI: 10.12968/hmed.2015.76.4.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Incidental left bundle-branch block occurs in up to 1.5% of healthy adults without symptoms or signs of cardiovascular disease. It may be found during investigation for non-cardiac disease, during preoperative assessment, private health screening or inpatient monitoring. This article outlines how to assess these patients.
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Affiliation(s)
- Luke Mair
- Senior House Officer in the Department of Critical Care, Doncaster Royal Infirmary, Doncaster, South Yorkshire DN2 5LT
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39
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Haataja P, Anttila I, Nikus K, Eskola M, Huhtala H, Nieminen T, Jula A, Salomaa V, Reunanen A, Nieminen MS, Lehtimäki T, Sclarovsky S, Kähönen M. Prognostic implications of intraventricular conduction delays in a general population: the Health 2000 Survey. Ann Med 2015; 47:74-80. [PMID: 25613171 DOI: 10.3109/07853890.2014.985704] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We examined the prognostic impact of eight different intraventricular conduction delays (IVCD) in the standard electrocardiogram (ECG) in a community cohort. METHODS AND RESULTS Data were collected from 6299 Finnish individuals. During a mean 8.2 years (interquartile range 8.1 to 8.3) of follow-up 640 subjects died (10.2%); 277 (4.4%) were cardiovascular deaths. For both sexes, all-cause and cardiovascular mortality was higher in subjects with IVCD than in those without. In Cox regression analysis after adjustment for age and gender, the hazard ratio for cardiovascular mortality for non-specific IVCD was 4.25 (95% confidence interval [CI] 1.95-9.26, P < 0.0001) and for left bundle branch block (LBBB) 2.11 (95% CI 1.31-3.41, P = 0.002). Right bundle branch block (RBBB) was not related to additional mortality, while incomplete RBBB (IRBBB) presented a hazard ratio of 2.24 (95% CI 1.064-4.77, P = 0.036). CONCLUSIONS In the general population, non-specific IVCD, LBBB, and IRBBB were associated with increased relative risk for all-cause and cardiovascular mortality. RBBB did not have an impact on cardiovascular mortality either in subjects with or without previous heart disease.
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Affiliation(s)
- Petri Haataja
- Heart Center Co, Tampere University Hospital , Tampere , Finland
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40
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Mordi I, Tzemos N. Non-invasive assessment of coronary artery disease in patients with left bundle branch block. Int J Cardiol 2015; 184:47-55. [PMID: 25697870 DOI: 10.1016/j.ijcard.2015.01.084] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
There is a high prevalence of coronary artery disease (CAD) in patients with left bundle branch block (LBBB); however there are many other causes for this electrocardiographic abnormality. Non-invasive assessment of these patients remains difficult, and all commonly used modalities exhibit several drawbacks. This often leads to these patients undergoing invasive coronary angiography which may not have been necessary. In this review, we examine the uses and limitations of commonly performed non-invasive tests for diagnosis of CAD in patients with LBBB.
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Affiliation(s)
- Ify Mordi
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Nikolaos Tzemos
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom.
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Naruse Y, Tada H, Harimura Y, Ishibashi M, Noguchi Y, Sato A, Hoshi T, Sekiguchi Y, Aonuma K. Early repolarization increases the occurrence of sustained ventricular tachyarrhythmias and sudden death in the chronic phase of an acute myocardial infarction. Circ Arrhythm Electrophysiol 2014; 7:626-32. [PMID: 24863485 DOI: 10.1161/circep.113.000939] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI. METHODS AND RESULTS This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences. CONCLUSIONS ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death.
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Affiliation(s)
- Yoshihisa Naruse
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Hiroshi Tada
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.).
| | - Yoshie Harimura
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Mayu Ishibashi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Yuichi Noguchi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Akira Sato
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Tomoya Hoshi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Yukio Sekiguchi
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
| | - Kazutaka Aonuma
- From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.)
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Abstract
Use of medications for attention-deficit hyperkinetic disorder and preparticipation sports physical examination has led to an increase in number of electrocardiograms (ECG) performed during adolescence. Interpreting ECGs in children and young adults must take into account the evolutionary changes with age and the benign variants, which are usually not associated with heart disease. It is crucial for primary-care providers to recognize the changes on ECG associated with heart disease and risk of sudden death. In this article, the significance, sensitivity, specificity, and the diagnostic workup of these findings in the asymptomatic teenager are discussed.
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Affiliation(s)
- Harinder R Singh
- Division of Cardiology, The Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubein, Detroit, MI 48201, USA.
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El-Menyar AA, Abdou SM. Impact of left bundle branch block and activation pattern on the heart. Expert Rev Cardiovasc Ther 2014; 6:843-57. [DOI: 10.1586/14779072.6.6.843] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Haataja P, Nikus K, Kähönen M, Huhtala H, Nieminen T, Jula A, Reunanen A, Salomaa V, Sclarovsky S, Nieminen MS, Eskola M. Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: The Health 2000 Survey. Int J Cardiol 2013; 167:1953-60. [DOI: 10.1016/j.ijcard.2012.05.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
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Testa L, Latib A, De Marco F, De Carlo M, Agnifili M, Latini RA, Petronio AS, Ettori F, Poli A, De Servi S, Ramondo A, Napodano M, Klugmann S, Ussia GP, Tamburino C, Brambilla N, Colombo A, Bedogni F. Clinical Impact of Persistent Left Bundle-Branch Block After Transcatheter Aortic Valve Implantation With CoreValve Revalving System. Circulation 2013; 127:1300-7. [DOI: 10.1161/circulationaha.112.001099] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Conduction disturbances are relatively common after transcatheter aortic valve implantation. Previous data demonstrated an adverse impact of persistent left bundle-branch block (LBBB) after surgical aortic valve replacement. It is unclear whether new-onset LBBB may also impact the prognosis of patients after transcatheter aortic valve implantation.
Methods and Results—
Among 1060 patients treated with a CoreValve Revalving System transcatheter aortic valve implantation between October 2007 and April 2011 in high-volume centers in Italy, we analyzed those without LBBB or pacemaker at admission (879 patients [82.9%]). We further excluded those who underwent permanent pacemaker implantation within 48 hours after the procedure (61 patients [7%]), for a final study population of 818 patients. Among them, 224 patients (group A; 27.4%) developed a persistent LBBB and the remaining 594 (group B; 72.6%) did not. Clinical characteristics were similar between groups. A low implantation was significantly more frequent in group A (15% versus 9.8%,
P
=0.02). No patients were censored before 1 year (median follow-up period 438 days, interquartile range 174–798 days). Survival analyses and inherent log-rank tests showed that LBBB was not associated with higher all-cause mortality, cardiac mortality, or hospitalization for heart failure at 30 days or 1 year. At 30 days, but not at 1 year, group A had a significantly higher rate of pacemaker implantation.
Conclusions—
In this registry of high-volume centers, persistent LBBB after CoreValve Revalving System transcatheter aortic valve implantation showed no effect on hard end points. On the other hand, LBBB was associated with a higher short-term rate of pacemaker implantation.
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Affiliation(s)
- Luca Testa
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Azeem Latib
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Federico De Marco
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Marco De Carlo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Mauro Agnifili
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Roberto Adriano Latini
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Anna Sonia Petronio
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Federica Ettori
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Arnaldo Poli
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Stefano De Servi
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Angelo Ramondo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Massimo Napodano
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Silvio Klugmann
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Gian Paolo Ussia
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Corrado Tamburino
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Nedy Brambilla
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Antonio Colombo
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
| | - Francesco Bedogni
- From the Department of Cardiology, Istituto Clinico S. Ambrogio, IRCCS San Donato, Milan, Italy (L.T., M.A., R.A., N.B., F.B.); San Raffaele Hospital, Milan, Italy (A.L., S.K., A.C.); Niguarda Ca Granda Hospital, Milan, Italy (F.D.M.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (F.E.); Azienda Ospedaliera Legnano, Legnano, Italy (A.P., S.D.S.); Ospedale di Bassano del Grappa
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Azadani PN, Soleimanirahbar A, Marcus GM, Haight TJ, Hollenberg M, Olgin JE, Lee BK. Asymptomatic Left Bundle Branch Block Predicts New-Onset Congestive Heart Failure and Death From Cardiovascular Diseases. Cardiol Res 2012; 3:258-263. [PMID: 28352414 PMCID: PMC5358299 DOI: 10.4021/cr214w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 12/04/2022] Open
Abstract
Background Left bundle branch block (LBBB) has been proposed as a risk factor for cardiovascular morbidity and mortality. We sought to characterize the strength of these associations in a population without preexisting clinical heart disease. Methods The association between LBBB and new-onset congestive heart failure (CHF) or death from cardiovascular diseases was examined in 1,688 participants enrolled in the SPPARCS study who were free of known CHF or previous myocardial infarction. SPPARCS is a community-based cohort study in residents of Sonoma, California that are > 55 years. Medical history and 12-lead ECGs were obtained every 2 years for up to 6 years of follow-up. LBBB at enrollment or year 2 was considered “baseline” and assessed as a predictor of CHF and cardiovascular death ascertained at years 4 and 6. Results The prevalence of LBBB at baseline was 2.5% (n = 42). During 6 years of follow-up, 70 (4.8%) people developed new CHF. Incidence of CHF was higher in patients with LBBB than in participants without LBBB. This association persisted after controlling for potential confounders (odds ratio (OR): 2.85; 95% confidence interval (CI): 1.01 - 8.02; P = 0.047). A higher mortality from cardiovascular diseases was also found in participants with LBBB after adjusting for potential confounders (OR: 2.35, 95%CI: 1.02 - 5.41; P = 0.044). Conclusions LBBB in the absence of a clinically detectable heart disease is associated with new-onset CHF and death from cardiovascular diseases. Further study is warranted to determine if additional diagnostic testing or earlier treatment in patients with asymptomatic LBBB can decrease cardiovascular morbidity or mortality.
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Affiliation(s)
| | - Ata Soleimanirahbar
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Gregory M Marcus
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Thaddeus J Haight
- University of California, Berkeley, School of Public Health, Berkeley, CA, USA
| | - Milton Hollenberg
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Jeffrey E Olgin
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Byron K Lee
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
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Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 2011; 28:1133-40. [DOI: 10.1007/s10554-011-9931-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/20/2011] [Indexed: 01/19/2023]
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48
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Hypertrophies and intraventricular conduction defects: causes, presentation, and significance. Dimens Crit Care Nurs 2011; 29:259-75. [PMID: 20940577 DOI: 10.1097/dcc.0b013e3181f0be8d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There is an increasing need for nurses to interpret a 12-lead electrocardiogram, both in critical care units and in other areas. This can be a challenging task, especially in the presence of hypertrophies, bundle-branch blocks, and fascicular blocks. This article reviews the pathophysiology of intraventricular blocks and hypertrophy, characteristics found in the 12-lead electrocardiogram, and discusses what the significance of these findings may be.
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49
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The relationship between intermittent left bundle-branch block and slow coronary flow in a patient presenting with acute coronary syndrome. Blood Coagul Fibrinolysis 2010; 21:595-7. [DOI: 10.1097/mbc.0b013e32833a901c] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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der Maur CA, Cuculi F, Zuber M, Kurtz C, Hoffmann A, Allgayer B, Erne P. Assessing ischemic heart disease in patients with left bundle branch block--an emerging role for multislice computed tomography. Int J Cardiol 2009; 137:68-71. [PMID: 18706716 DOI: 10.1016/j.ijcard.2008.05.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Accepted: 05/03/2008] [Indexed: 11/28/2022]
Abstract
Diagnosis of left bundle branch block (LBBB) with concomitant coronary artery disease (CAD) alters the prognosis and the therapeutic management. All common non-invasive stress tests have a limited performance to identify CAD in patients with LBBB. Thus invasive coronary angiography is often needed to confirm or defer obstructive CAD. We propose a new diagnostic algorithm in evaluation of symptomatic and asymptomatic patients with LBBB.
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