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Zhao H, Li M, Wu D, Chen S, Zhu C, Lan Y, Liu H, Wu Y, Wu S. Physical Activity Modifies the Risk of Incident Cardiac Conduction Disorders Upon Inflammation: A Population-Based Cohort Study. J Am Heart Assoc 2024; 13:e034754. [PMID: 39158550 DOI: 10.1161/jaha.124.034754] [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: 01/30/2024] [Accepted: 07/24/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Emerging evidence suggests a central role for inflammation in cardiac conduction disorder (CCD). It is unknown whether habitual physical activity could modulate the inflammation-associated risks of incident CCD in the general population. METHODS AND RESULTS This population-based cohort was derived from the China Kailuan study, including a total of 97 192 participants without prior CCD. The end points included incident CCD and its subcategories (atrioventricular block and bundle-branch block). Systemic inflammation was indicated by the monocyte-to-lymphocyte ratio (MLR). Over a median 10.91-year follow-up, 3747 cases of CCD occurred, with 1062 cases of atrioventricular block and 2697 cases of bundle-branch block. An overall linear dose-dependent relationship was observed between MLR and each study end point (all P-nonlinearity≥0.05). Both higher MLR and physical inactivity were significantly associated with higher risks of conduction block. The MLR-associated risks of developing study end points were higher in the physically inactive individuals than in those being physically active, with significant interactions between MLR levels and physical activity for developing CCD (P-interaction=0.07) and bundle-branch block (P-interaction<0.05) found. Compared with those in MLR quartile 2 and being physically active, those in the highest MLR quartile and being physically inactive had significantly higher risks for all study end points (1.42 [95% CI, 1.24-1.63], 1.62 [95% CI, 1.25-2.10], and 1.33 [95% CI, 1.13-1.56], respectively, for incident CCD, atrioventricular block, and bundle-branch block). CONCLUSIONS MLR should be a biomarker for the risk assessment of incident CCD. Adherence to habitual physical activity is favorable for reducing the MLR-associated risks of CCD.
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Affiliation(s)
- Haiyan Zhao
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Man Li
- Graduate School North China University of Science and Technology Tangshan China
| | - Dan Wu
- Department of Pediatrics Second Affiliated Hospital of Shantou University Medical College Shantou Guangdong China
- Centre for Precision Health Edith Cowan University School of Medical and Health Sciences Joondalup WA USA
| | - Shuohua Chen
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Chenrui Zhu
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Yulong Lan
- Centre for Precision Health Edith Cowan University School of Medical and Health Sciences Joondalup WA USA
- Department of Cardiology Second Affiliated Hospital of Shantou University Medical College Shantou Guangdong China
| | - Hongmin Liu
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Yuntao Wu
- Department of Cardiology Kailuan General Hospital Tangshan China
| | - Shouling Wu
- Department of Cardiology Kailuan General Hospital Tangshan China
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Amaral Marques C, Laura Costa A, Martins E. Left bundle branch block-induced dilated cardiomyopathy: Definitions, pathophysiology, and therapy. Rev Port Cardiol 2024:S0870-2551(24)00081-7. [PMID: 38615881 DOI: 10.1016/j.repc.2024.02.004] [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: 05/03/2023] [Revised: 11/18/2023] [Accepted: 02/07/2024] [Indexed: 04/16/2024] Open
Abstract
Left bundle branch block (LBBB) is a frequent finding in patients with heart failure (HF), particularly in those with dilated cardiomyopathy (DCM). LBBB has been commonly described as a consequence of DCM development. However, a total recovery of left ventricular (LV) function after cardiac resynchronization therapy (CRT), observed in patients with LBBB and DCM, has led to increasing acknowledgement of LBBB-induced dilated cardiomyopathy (LBBB-iDCM) as a specific pathological entity. Its recognition has important clinical implications, as LBBB-iDCM patients may benefit from an early CRT strategy rather than medical HF therapy only. At present, there are no definitive diagnostic criteria enabling the universal identification of LBBB-iDCM, and no defined therapeutic approach in this subgroup of patients. This review compiles the main findings about LBBB-iDCM pathophysiology and the current proposed diagnostic criteria and therapeutic approach.
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Affiliation(s)
- Catarina Amaral Marques
- Faculty of Medicine - University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal.
| | | | - Elisabete Martins
- Faculty of Medicine - University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar Universitário São João, Porto, Portugal
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Ahmed M, Nudy M, Bussa R, Weigel F, Naccarelli G, Maheshwari A. Non-pharmacologic autonomic neuromodulation for treatment of heart failure: A systematic review and meta-analysis of randomized controlled trials. Trends Cardiovasc Med 2024; 34:101-107. [PMID: 36202286 DOI: 10.1016/j.tcm.2022.09.007] [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: 07/10/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Treatment strategies that modulate autonomic tone through interventional and device-based therapies have been studied as an adjunct to pharmacological treatment of heart failure with reduced ejection fraction (HFrEF). The main objective of this study was to perform a meta-analysis of randomized controlled trials which evaluated the efficacy of device-based autonomic modulation for treatment of HFrEF. All randomized-controlled trials testing autonomic neuromodulation device therapy in HFrEF were included in this trial-level analysis. Autonomic neuromodulation techniques included vagal nerve stimulation (VNS), baroreflex activation (BRA), spinal cord stimulator (SCS), and renal denervation (RD). The prespecified primary endpoints included mean change and 95% confidence intervals (CI) of left ventricular ejection fraction (LVEF), NT pro-B-type natriuretic peptide (NT-proBNP), and quality of life (QOL) measures including 6-minute hall walk distance (6-MHWD), and Minnesota Living with Heart Failure Questionnaire (MLHFQ). New York Heart Association (NYHA) functional class improvement was reported as odds ratios and 95% CI of improvement by at least 1 functional class. Eight studies were identified that included 1037 participants (2 VNS, 2 BRA, 1 SCS, and 3 RD trials). This included 6 open-label, 1 single-blind, and 1 sham-controlled, double-blind study. The mean age (±SD) was 61 (±9.3) years. The mean follow-up time was 7.9 months. Twenty percent of the total patients were female, and the mean BMI (±SD) was 29.86 (±4.12). Autonomic neuromodulation device therapy showed a statistically significant improvement in LVEF (4.02%; 95% CI 0.24,7.79), NT-proBNP (-219.80 pg/ml; 95% CI -386.56, -53.03), NYHA functional class (OR 2.32; 95% CI 1.76, 3.07), 6-MHWD (48.39 m; 95% CI 35.49, 61.30), and MLHFQ (-12.20; 95% CI -19.24, -5.16) compared to control. In patients with HFrEF, the use of autonomic neuromodulation device therapy is associated with improvement in LVEF, reduction in NT-proBNP, and improvement in patient-centered QOL outcomes in mostly small open-label trials. Large, double-blind, sham-controlled trials designed to detect differences in hard cardiovascular outcomes are needed before widespread use and adoption of autonomic neuromodulation device therapies in HFrEF.
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Affiliation(s)
- Mohammad Ahmed
- Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, United States of America
| | - Matthew Nudy
- Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, PA 17033, United States of America
| | - Rahul Bussa
- Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, United States of America
| | - Frank Weigel
- Department of Internal Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, United States of America
| | - Gerald Naccarelli
- Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, PA 17033, United States of America
| | - Ankit Maheshwari
- Division of Cardiology, Penn State Hershey Medical Center, Heart and Vascular Institute, Hershey, PA 17033, United States of America.
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Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
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Frimodt-Møller EK, Vittinghoff E, Kaur G, Biering-Sørensen T, Soliman EZ, Marcus GM. Association Between Intensive vs Standard Blood Pressure Control and Incident Left Ventricular Conduction Disease: A Post Hoc Analysis of the SPRINT Randomized Clinical Trial. JAMA Cardiol 2023; 8:612-616. [PMID: 37133829 PMCID: PMC10157506 DOI: 10.1001/jamacardio.2023.0845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/28/2023] [Indexed: 05/04/2023]
Abstract
Importance Left ventricular conduction disease predicts heart failure and death, and the only strategies to mitigate its effects involve implantation of a permanent pacemaker. There are currently no proven preventive strategies for this common condition. Objective To determine the association between targeting intensive blood pressure (BP) control and the risk of developing left ventricular conduction disease. Design, Setting, and Participants This was a post hoc analysis of the 2-arm multicenter Systolic Blood Pressure Intervention Trial (SPRINT), which recruited participants from 102 sites in the US and Puerto Rico and was conducted from November 2010 until August 2015. Adults 50 years and older with hypertension and at least 1 other cardiovascular risk factor were included. Participants with baseline left ventricular conduction disease, ventricular pacing, or ventricular pre-excitation were excluded for the current analysis. Data were analyzed from November 2021 to November 2022. Intervention Participants were randomly assigned to a systolic BP target of less than 140 mm Hg (standard treatment group) or less than 120 mm Hg (intensive treatment group). Main Outcome The primary outcome was incident left ventricular conduction disease, including any fascicular or left bundle-branch block, assessed by serial electrocardiography. Incident right bundle-branch block was examined as a negative control. Results Among 3918 participants randomized to standard treatment and 3956 to intensive treatment (mean [SD] age, 67.6 [9.2] years; 2815 [36%] female) monitored for a median [IQR] 3.5 (0.02-5.2) years, 203 developed left ventricular conduction disease. Older age (hazard ratio per 10-year increase [HR], 1.42; 95% CI, 1.21-1.67; P < .001), male sex (HR, 2.31; 95% CI, 1.63-3.32; P < .001), and cardiovascular disease (HR, 1.46; 95% CI, 1.06-2.00; P = .02) were associated with a higher risk of left ventricular conduction disease. Assignment to intensive treatment was associated with a 26% lower risk of left ventricular conduction disease (HR, 0.74; 95% CI, 0.56-0.98; P = .04). These results persisted when incident ventricular pacing was included in the outcome and when considering all-cause death as a competing risk. In contrast, no association between randomization assignment and right bundle-branch block was observed (HR, 0.95; 95% CI, 0.71-1.27; P = .75). Conclusions and Relevance In this study, targeting intensive BP control was associated with lower risk of left ventricular conduction disease in a randomized clinical trial, suggesting that clinically relevant conduction disease may be preventable. Trial Registration ClinicalTrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Emilie K. Frimodt-Møller
- Division of Cardiology, Department of Medicine, University of California San Francisco
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Eric Vittinghoff
- Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Gurbani Kaur
- Division of Cardiology, Department of Medicine, University of California San Francisco
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Elsayed Z. Soliman
- Section of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gregory M. Marcus
- Division of Cardiology, Department of Medicine, University of California San Francisco
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Frimodt-Møller EK, Soliman EZ, Kizer JR, Vittinghoff E, Psaty BM, Biering-Sørensen T, Gottdiener JS, Marcus GM. Lifestyle habits associated with cardiac conduction disease. Eur Heart J 2023; 44:1058-1066. [PMID: 36660815 PMCID: PMC10226753 DOI: 10.1093/eurheartj/ehac799] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS Cardiac conduction disease can lead to syncope, heart failure, and death. The only available therapy is pacemaker implantation, with no established prevention strategies. Research to identify modifiable risk factors has been scant. METHODS AND RESULTS Data from the Cardiovascular Health Study, a population-based cohort study of adults ≥ 65 years with annual 12-lead electrocardiograms obtained over 10 years, were utilized to examine relationships between baseline characteristics, including lifestyle habits, and conduction disease. Of 5050 participants (mean age 73 ± 6 years; 52% women), prevalent conduction disease included 257 with first-degree atrioventricular block, 99 with left anterior fascicular block, 9 with left posterior fascicular block, 193 with right bundle branch block (BBB), 76 with left BBB, and 102 with intraventricular block at baseline. After multivariable adjustment, older age, male sex, a larger body mass index, hypertension, and coronary heart disease were associated with a higher prevalence of conduction disease, whereas White race and more physical activity were associated with a lower prevalence. Over a median follow-up on 7 (interquartile range 1-9) years, 1036 developed incident conduction disease. Older age, male sex, a larger BMI, and diabetes were each associated with incident conduction disease. Of lifestyle habits, more physical activity (hazard ratio 0.91, 95% confidence interval 0.84-0.98, P = 0.017) was associated with a reduced risk, while smoking and alcohol did not exhibit a significant association. CONCLUSION While some difficult to control comorbidities were associated with conduction disease as expected, a readily modifiable lifestyle factor, physical activity, was associated with a lower risk.
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Affiliation(s)
- Emilie K Frimodt-Møller
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elsayed Z Soliman
- Department of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge R Kizer
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Washington, WA 98195-9458, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John S Gottdiener
- Division of Cardiology, University of Maryland, Baltimore, MD 21201, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
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Rimskaya EM, Mironova NA, Sokolov SF, Golitsyn SP. [Left bundle branch block - dilated cardiomyopathy - heart failure: common links in the closed pathogenetic chain]. KARDIOLOGIIA 2023; 63:68-76. [PMID: 36880146 DOI: 10.18087/cardio.2023.2.n1773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/23/2021] [Indexed: 03/08/2023]
Abstract
This review summarizes the available information on the epidemiology and prognosis of patients with left bundle branch block (LBBB), morphological alterations of the myocardium both resulting in and ensuing LBBB, cardiac biomechanics in LBBB, and possibilities of its correction.
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Affiliation(s)
- E M Rimskaya
- Chazov National Medical Research Center of Cardiology
| | - N A Mironova
- Chazov National Medical Research Center of Cardiology
| | - S F Sokolov
- Chazov National Medical Research Center of Cardiology
| | - S P Golitsyn
- Chazov National Medical Research Center of Cardiology
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Peng ML, Fu Y, Zhang Y, Wu CW, Ren H, Zhou SS. Recovery of complete left bundle branch block in a dilated cardiomyopathy patient after treatment with sacubitril/valsartan: A case report. Medicine (Baltimore) 2022; 101:e29330. [PMID: 35801756 PMCID: PMC9259124 DOI: 10.1097/md.0000000000029330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The treatment of dilated cardiomyopathy (DCM) has recently been greatly improved, especially with the widespread use of sacubitril/valsartan (ARNI) combination therapy. We know that ARNI-like drugs can significantly improve the symptoms of heart failure with reducing ejection fraction. However, clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. In this case, we report a patient with complete left bundle branch block (CLBBB) associated with DCM whose CLBBB returned to normal after treatment with ARNI. PATIENT CONCERNS A 38-year-old man was admitted to the hospital for 20 days for idiopathic paroxysmal dyspnea. He presented with exacerbated dyspnea symptoms at night, accompanied by cough and sputum. DIAGNOSIS Physical examination revealed a grade 4/6 systolic murmur could be heard in the apical area of the heart and mild edema was present in both lower limbs. Laboratory examination found that the B-type natriuretic peptide was significantly increased. Echocardiography indicated left atrial internal diameter, right ventricular internal diameter, and left ventricular diastolic diameter were enlarged and ejection fraction was significantly decreased. Besides, the pulsation of the wall was diffusely attenuated. Electrocardiogram was suggestive of tachycardia and CLBBB. A diagnosis of DCM with CLBBB was considered based on a comprehensive evaluation of the physical examination, laboratory examination, echocardiography and electrocardiogram. INTERVENTIONS The patient was treated with ARNI at a dose of 50 mg (twice a day) at first, gradually increasing to the target dose (200 mg, twice a day) in the following 9 months as shown in Table 1, along with metoprolol 25 mg (once a day [qd]), diuretics 20 mg (qd), and aldosterone 20 mg (qd). OUTCOMES After treatment with ARNI during the 9-month follow-up, the patient's symptoms improved, and CLBBB returned to normal. LESSONS Clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. This report will help to instruct the clinical treatment of DCM patients with CLBBB and the potential application of ARNI.
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Affiliation(s)
- Meng-Ling Peng
- Department of Cardiology, The First Hospital of Jilin University, Chaoyang District, Changchun, People’s Republic of China
| | - Yu Fu
- Department of Cardiology, The First Hospital of Jilin University, Chaoyang District, Changchun, People’s Republic of China
| | - Ying Zhang
- Department of Cardiology, The First Hospital of Jilin University, Chaoyang District, Changchun, People’s Republic of China
| | - Chu-Wen Wu
- Department of Cardiology, The First Hospital of Jilin University, Chaoyang District, Changchun, People’s Republic of China
| | - Hang Ren
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, People’s Republic of China
| | - Shan-Shan Zhou
- Department of Cardiology, The First Hospital of Jilin University, Chaoyang District, Changchun, People’s Republic of China
- *Correspondence: Shan-Shan Zhou, The First Hospital of Jilin University, No. 1 Xinmin Street, Chaoyang District, Changchun 130021, People’s Republic of China (e-mail: )
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9
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Zeng Y, Yang S, Yu X, Lin W, Wang W, Tong J, Xia S. A multimodal parallel method for left ventricular dysfunction identification based on phonocardiogram and electrocardiogram signals synchronous analysis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:9612-9635. [PMID: 35942775 DOI: 10.3934/mbe.2022447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Heart failure (HF) is widely acknowledged as the terminal stage of cardiac disease and represents a global clinical and public health problem. Left ventricular ejection fraction (LVEF) measured by echocardiography is an important indicator of HF diagnosis and treatment. Early identification of LVEF reduction and early treatment is of great significance to improve LVEF and the prognosis of HF. This research aims to introduce a new method for left ventricular dysfunction (LVD) identification based on phonocardiogram (ECG) and electrocardiogram (PCG) signals synchronous analysis. In the present study, we established a database called Synchronized ECG and PCG Database for Patients with Left Ventricular Dysfunction (SEP-LVDb) consisting of 1046 synchronous ECG and PCG recordings from patients with reduced (n = 107) and normal (n = 699) LVEF. 173 and 873 recordings were available from the reduced and normal LVEF group, respectively. Then, we proposed a parallel multimodal method for LVD identification based on synchronous analysis of PCG and ECG signals. Two-layer bidirectional gate recurrent unit (Bi-GRU) was used to extract features in the time domain, and the data were classified using residual network 18 (ResNet-18). This research confirmed that fused ECG and PCG signals yielded better performance than ECG or PCG signals alone, with an accuracy of 93.27%, precision of 93.34%, recall of 93.27%, and F1-score of 93.27%. Verification of the model's performance with an independent dataset achieved an accuracy of 80.00%, precision of 79.38%, recall of 80.00% and F1-score of 78.67%. The Bi-GRU model outperformed Bi-directional long short-term memory (Bi-LSTM) and recurrent neural network (RNN) models with a best selection frame length of 3.2 s. The Saliency Maps showed that SEP-LVDPN could effectively learn features from the data.
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Affiliation(s)
- Yajing Zeng
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Siyu Yang
- School of Information and Technology, Zhejiang Sci-Tech University, Hangzhou 310000, China
| | - Xiongkai Yu
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Wenting Lin
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Wei Wang
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
| | - Jijun Tong
- School of Information and Technology, Zhejiang Sci-Tech University, Hangzhou 310000, China
| | - Shudong Xia
- The Fourth Affiliated Hospital Zhejiang University School of Medicine, Jinhua 321000, China
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Straw S, McGinlay M, Gierula J, Lowry JE, Paton MF, Cole C, Drozd M, Koshy AO, Mullens W, Cubbon RM, Kearney MT, Witte KK. Impact of QRS duration on left ventricular remodelling and survival in patients with heart failure. J Cardiovasc Med (Hagerstown) 2021; 22:848-856. [PMID: 34261079 DOI: 10.2459/jcm.0000000000001231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS In patients with chronic heart failure, QRS duration is a consistent predictor of poor outcomes. It has been suggested that for indicated patients, cardiac resynchronization therapy (CRT) could come sooner in the treatment algorithm, perhaps in parallel with the attainment of optimal guideline-directed medical therapy (GDMT). We aimed to investigate differences in left ventricular (LV) remodelling in those with narrow QRS (NQRS) compared with wide QRS (WQRS) in the absence of CRT, whether an early CRT strategy resulted in unnecessary implants and the effect of early CRT on outcomes. METHODS Our cohort consisted of 214 consecutive patients with LV ejection fraction (LVEF) of 35% or less who underwent repeat echocardiography 1 year after enrolment. Of these, 116 patients had NQRS, and 98 had WQRS of whom 40 received CRT within 1 year and 58 did not. RESULTS In the absence of CRT, patients with WQRS had less LV reverse remodelling compared with those with NQRS, with differences in ΔLVEF (+2 vs. +9%, P < 0.001) ΔLV end-diastolic diameter (-1 vs. -2 mm, P = 0.095), ΔLV end-systolic diameter (-2 vs. -4.5 mm, P = 0.038), LV end-systolic volume (-12.6 vs. -25.0 ml, P = 0.054) and LV end-diastolic volume (-7.3 vs. -12.2 ml, P = 0.071). LVEF was more likely to improve by at least 10% if patients had NQRS or received CRT (P = 0.08). Thirteen (24%) patients with WQRS achieved an LVEF greater than 35% in the absence of CRT; however, none achieved greater than 50%. CONCLUSION A strictly linear approach to heart failure therapy might lead to delays to optimal treatment in those patients with the most to gain from CRT and the least to gain from GDMT.
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Affiliation(s)
- Sam Straw
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Melanie McGinlay
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Gierula
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Judith E Lowry
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Maria F Paton
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Charlotte Cole
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Michael Drozd
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Aaron O Koshy
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, University Hasselt, Genk, Belgium
| | - Richard M Cubbon
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Mark T Kearney
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
| | - Klaus K Witte
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
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11
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Sletten OJ, Aalen JM, Izci H, Duchenne J, Remme EW, Larsen CK, Hopp E, Galli E, Sirnes PA, Kongsgard E, Donal E, Voigt JU, Smiseth OA, Skulstad H. Lateral Wall Dysfunction Signals Onset of Progressive Heart Failure in Left Bundle Branch Block. JACC Cardiovasc Imaging 2021; 14:2059-2069. [PMID: 34147454 DOI: 10.1016/j.jcmg.2021.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to investigate if contractile asymmetry between septum and left ventricular (LV) lateral wall drives heart failure development in patients with left bundle branch block (LBBB) and whether the presence of lateral wall dysfunction affects potential for recovery of LV function with cardiac resynchronization therapy (CRT). BACKGROUND LBBB may induce or aggravate heart failure. Understanding the underlying mechanisms is important to optimize timing of CRT. METHODS In 76 nonischemic patients with LBBB and 11 controls, we measured strain using speckle-tracking echocardiography and regional work using pressure-strain analysis. Patients with LBBB were stratified according to LV ejection fraction (EF) ≥50% (EFpreserved), 36% to 49% (EFmid), and ≤35% (EFlow). Sixty-four patients underwent CRT and were re-examined after 6 months. RESULTS Septal work was successively reduced from controls, through EFpreserved, EFmid, and EFlow (all p < 0.005), and showed a strong correlation to left ventricular ejection fraction (LVEF; r = 0.84; p < 0.005). In contrast, LV lateral wall work was numerically increased in EFpreserved and EFmid versus controls, and did not significantly correlate with LVEF in these groups. In EFlow, however, LV lateral wall work was substantially reduced (p < 0.005). There was a moderate overall correlation between LV lateral wall work and LVEF (r = 0.58; p < 0.005). In CRT recipients, LVEF was normalized (≥50%) in 54% of patients with preserved LV lateral wall work, but only in 13% of patients with reduced LV lateral wall work (p < 0.005). CONCLUSIONS In early stages, LBBB-induced heart failure is associated with impaired septal function but preserved lateral wall function. The advent of LV lateral wall dysfunction may be an optimal time-point for CRT.
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Affiliation(s)
- Ole J Sletten
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John M Aalen
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hava Izci
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jürgen Duchenne
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Espen W Remme
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; The Intervention Center, Oslo University Hospital, Oslo, Norway
| | - Camilla K Larsen
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Einar Hopp
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Elena Galli
- Department of Cardiology, Centre Hospitalier Universitaire de Rennes and Inserm, Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
| | | | - Erik Kongsgard
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erwan Donal
- Department of Cardiology, Centre Hospitalier Universitaire de Rennes and Inserm, Laboratoire Traitement du Signal et de l'Image, University of Rennes, Rennes, France
| | - Jens U Voigt
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Otto A Smiseth
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helge Skulstad
- Institute for Surgical Research, Rikshospitalet, Oslo University Hospital and University of Oslo, Oslo, Norway; Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
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12
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Ocaranza MP, Jalil JE, Altamirano R, de León A, Moya J, Lonis A, Gabrielli L, Nab PM, Córdova S, Paredes A, Vergara I, Bittner A, Sabat K, Pastorini K. Reverse Remodeling in Human Heart Failure after Cardiac Resynchronization Therapy Is Associated With Reduced RHO-Kinase Activation. Front Pharmacol 2021; 12:565724. [PMID: 33967744 PMCID: PMC8104930 DOI: 10.3389/fphar.2021.565724] [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: 05/26/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Reverse remodeling is a clinically relevant endpoint in heart failure with reduced ejection fraction (HFrEF). Rho-kinase (ROCK) signaling cascade activation correlates with cardiac remodeling and left ventricular (LV) systolic dysfunction in HFrEF patients. Cardiac resynchronization therapy (CRT) is effective in HFrEF, especially when there is a left bundle block, as this treatment may stimulate reverse remodeling, thereby improving quality of life and prolonging survival for patients with this severe condition. Here, we evaluate the hypothesis that ROCK activation is reduced after effective CRT in HFrEF. Methods: ROCK activation in circulating leukocytes was evaluated in 28 HFrHF patients, using Western blot (myosin light chain phosphatase subunit 1 phosphorylation, MYPT1p/t), before and three months after initiation of CRT. LV systolic function and remodeling were assessed by echocardiography. Results: Three months after CRT, LV ejection fraction increased an average of 14.5% (p < 0.001) in 13 patients (responders), while no change was observed in 15 patients (non-responders). End-systolic diameter decreased 16% (p < 0.001) in responders, with no change in non-responders. ROCK activation in PBMCs decreased 66% in responders (p < 0.05) but increased 10% in non-responders (NS). LV end-diastolic diameter was also 5.2 mm larger in non-responders vs. responders (p = 0.058). LV ejection fraction, systolic diameter, and ROCK activation levels were similar in both groups at baseline. Conclusion: In HFrEF patients, 3 months of effective CRT induced reverse myocardial remodeling, and ROCK activation was significantly decreased in circulating leukocytes. Thus, decreased ROCK activation in circulating leukocytes may reflect reverse cardiac remodeling in patients with heart failure.
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Affiliation(s)
- Maria Paz Ocaranza
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile.,Center for New Drugs for Hypertension (CENDHY), Pontificia Universidad Católica de Chile, Santiago, Chile.,Pontificia Universidad Católica de Chile, School of Medicine, Advanced Center for Chronic Diseases (ACCDiS), Santiago, Chile
| | - Jorge E Jalil
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile.,Center for New Drugs for Hypertension (CENDHY), Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Ana de León
- Servicio de Cardiología, Hospital Sótero del Río, Santiago, Chile
| | - Jackeline Moya
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Alejandra Lonis
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Luigi Gabrielli
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Paul Mac Nab
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Samuel Córdova
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Alejandro Paredes
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Ismael Vergara
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Alex Bittner
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Karime Sabat
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Cardiovascular Diseases, Santiago, Chile
| | - Karla Pastorini
- Servicio de Cardiología, Hospital Sótero del Río, Santiago, Chile
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13
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A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. JACC Cardiovasc Imaging 2021; 14:1691-1702. [PMID: 33865764 DOI: 10.1016/j.jcmg.2021.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/15/2021] [Accepted: 02/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study speculated that longitudinal strain curves in left bundle branch block (LBBB) could be shaped by the degree of LBBB-induced cardiac remodeling. BACKGROUND LBBB independently affects left ventricular (LV) structure and function, but large individual variability may exist in LBBB-induced adverse remodeling. METHODS Consecutive patients with LBBB with septal flash (LBBB-SF) underwent thorough echocardiographic assessment, including speckle tracking-based strain analysis. Four major septal longitudinal strain patterns (LBBB-1 through LBBB-4) were discerned and staged on the basis of: 1) correlation analysis with echocardiographic indexes of cardiac remodeling, including the extent of SF; 2) strain pattern analysis in cardiac resynchronization therapy (CRT) super-responders; and 3) strain pattern analysis in patients with acute procedural-induced LBBB. RESULTS The study enrolled 237 patients with LBBB-SF (mean age: 67 ± 13 years; 57% men). LBBB-1 was observed in 60 (26%), LBBB-2 in 118 (50%), LBBB-3 in 29 (12%), and LBBB-4 in 26 (11%) patients. Patients at higher LBBB stages had larger end-diastolic volumes, lower LV ejection fractions, longer QRS duration, increased mechanical dyssynchrony, and more prominent SF compared with less advanced stages (p < 0.001 for all). Among CRT super-responders (n = 30; mean age: 63 ± 10 years), an inverse transition from stages LBBB-3 and -4 (pre-implant) to stages LBBB-1 and -2 (pace-off, median follow-up of 66 months [interquartile range: 32 to 78 months]) was observed (p < 0.001). Patients with acute LBBB (n = 27; mean age: 83 ± 5.1 years) only presented with a stage LBBB-1 (72%) or -2 pattern (24%). CONCLUSIONS The proposed classification suggests a pathophysiological continuum of LBBB-induced LV remodeling and may be valuable to assess the attribution of LBBB to the extent of LV remodeling and dysfunction.
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14
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Kurisu S, Nitta K, Watanabe N, Ikenaga H, Ishibashi K, Fukuda Y, Nakano Y. Effects of Newly Developed Right Versus Left Bundle Branch Block on the QRS Axis, T-wave Axis and Frontal QRS-T Angle in Patients with a Narrow QRS. Intern Med 2021; 60:25-30. [PMID: 32788526 PMCID: PMC7835454 DOI: 10.2169/internalmedicine.5442-20] [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] [Indexed: 01/30/2023] Open
Abstract
Objective The QRS-T angle has been established as a repolarization marker. In the present study, we determined whether or not newly developed bundle branch block (BBB) affected the QRS-T angle in patients with a narrow QRS. Methods Twenty-four patients with newly developed BBB and no adverse cardiac events were retrospectively included. The frontal QRS-T angle was defined as the absolute value of the difference between the frontal plane QRS axis and the T-wave axis. These electrocardiogram parameters were serially measured in the settings of narrow QRS and BBB. Results Twelve patients had newly developed right BBB (RBBB), and 12 had newly developed left BBB (LBBB). The development of RBBB did not affect the QRS axis, T-wave axis of QRS-T angle (41° ±42° to 53° ±65°, p = 0.63). In contrast, the development of LBBB shifted the QRS axis to the left (25° ±29° to -18° ±31°, p = 0.003), resulting in an increased QRS-T angle (72° ±50° to 123° ±39°, p = 0.001). Regarding RBBB, an excellent correlation and agreement were found between the QRS-T angles in the setting of narrow QRS and RBBB (r = 0.88; p <0.001; bias, 2.9° ±20.9°). However, there was a significant bias between the QRS-T angles in the setting of narrow QRS and LBBB (51.9° ±40.4°; p = 0.001). Conclusion Our data suggested that the QRS-T angle in the setting of RBBB reflected the original QRS-T angle in the setting of narrow QRS well, whereas the QRS-T angle in the setting of LBBB did not.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Noriaki Watanabe
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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15
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Vernooy K, Brunner-La Rocca HP. The importance of electrocardiographic follow-up in heart failure. Eur J Heart Fail 2020; 22:2380-2382. [PMID: 33179385 DOI: 10.1002/ejhf.2054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/08/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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16
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Maki H, Takeda N. Reverse Remodeling and Current Medical Therapy in Heart Failure with Reduced Ejection Fraction. Int Heart J 2020; 61:197-198. [PMID: 32224600 DOI: 10.1536/ihj.20-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Norihiko Takeda
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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17
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Abstract
Left bundle branch block may be due to conduction system degeneration or a reflection of myocardial pathology. Left bundle branch block may also develop following aortic valve disease or cardiac procedures. Patients with heart failure with reduced ejection fraction and left bundle branch block may respond positively to cardiac resynchronization therapy. Lead placement via the coronary sinus is the mainstay approach of cardiac resynchronization therapy. However, other options, including physiological pacing, are being explored. In this review, we summarize the salient pathophysiologic and clinical aspects of left bundle branch block, as well as current and future strategies for management.
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Affiliation(s)
- Nicholas Y Tan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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18
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Calle S, Delens C, Kamoen V, De Pooter J, Timmermans F. Septal flash: At the heart of cardiac dyssynchrony. Trends Cardiovasc Med 2020; 30:115-122. [DOI: 10.1016/j.tcm.2019.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/31/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
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19
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Mechanism of harm from left bundle branch block. Trends Cardiovasc Med 2019; 29:335-342. [DOI: 10.1016/j.tcm.2018.10.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 11/21/2022]
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20
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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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21
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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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