1
|
Margulescu AD, Thomas DE, Awadalla M, Shah P, Khurana A, Aldalati O, Obaid DR, Chase AJ, Smith D. Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00154-4. [PMID: 38604832 DOI: 10.1016/j.carrev.2024.04.011] [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: 12/29/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined. METHODS We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash). RESULTS At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline. CONCLUSIONS N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.
Collapse
Affiliation(s)
- Andrei D Margulescu
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Dewi E Thomas
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - Magid Awadalla
- Mater Private Network Hospital, Eccles Street, Dublin 7 D07 WKW8, Ireland.
| | - Parin Shah
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Ayush Khurana
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK.
| | - Omar Aldalati
- Department of Cardiology, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK.
| | - Daniel R Obaid
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - Alexander J Chase
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| | - David Smith
- Department of Cardiology, Morriston Regional Cardiac Centre, Morriston Hospital, Heol Maes Eglwys, Swansea SA6 6NL, UK; Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK.
| |
Collapse
|
2
|
Moubarak G, Viart G, Anselme F. Acute correction of electromechanical dyssynchrony and response to cardiac resynchronization therapy. ESC Heart Fail 2020; 7:1302-1308. [PMID: 32157825 PMCID: PMC7261585 DOI: 10.1002/ehf2.12654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Aims Echocardiographic measures of dyssynchrony at baseline have not demonstrated a good ability to predict response to cardiac resynchronization therapy (CRT). The purpose of this study was to determine if the acute correction of electromechanical dyssynchrony, assessed by the change in simple pulsed‐Doppler measures, was related to CRT response at 6 months. Methods and results Echocardiography was performed at baseline and at pre‐discharge after CRT implantation. Intraventricular, interventricular, and atrioventricular dyssynchrony were evaluated by the left pre‐ejection interval (LPEI), the interventricular mechanical delay, and the ratio of left ventricular filling time to RR interval, respectivelxy. A patient was considered responder if he/she was alive without hospitalization for heart failure and had an absolute increase of left ventricular ejection fraction (LVEF) >5 points. Forty‐eight patients (mean age 67 ± 11 years, 73% male, mean LVEF 30 ± 5%) were included. CRT led to an acute correction of intraventricular and interventricular dyssynchrony but not to an acute correction of atrioventricular dyssynchrony. There were 31 (65%) responders at 6 months. Two factors were independently associated with CRT response in multivariate analysis: ischemic cardiomyopathy (odds ratio 0.19, 95% confidence interval 0.04–0.87; P= 0.032) and delta LPEI (odds ratio 1.03 per 1 ms decrease, 95% confidence interval 1.01–1.05; P = 0.007). By receiver operating characteristic analysis, the optimal cut‐off value of delta LPEI was −16 ms. The proportion of responders in patients without ischemic cardiomyopathy and with a delta LPEI greater than −16 ms was 85%. Conclusions Acute correction of intraventricular electromechanical dyssynchrony evaluated by the LPEI predicted CRT response at 6 months.
Collapse
Affiliation(s)
- Ghassan Moubarak
- Department of Electrophysiology and Pacing, Centre Médico-Chirurgical Ambroise Paré, Neuilly-sur-Seine, France.,Department of Cardiology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Guillaume Viart
- Department of Cardiology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Frédéric Anselme
- Department of Cardiology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| |
Collapse
|