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Left bundle branch block in chronic heart failure-impact on diastolic function, filling pressures, and B-type
Christian Bruch1, Joerg Stypmann, Matthias Grude
1Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany. bruchc@uni-muenster.de
Insights
Left bundle branch block (LBBB) in chronic heart failure (CHF) patients is linked to worse diastolic dysfunction and higher NT-proBNP levels, even with similar systolic function. These factors may increase morbidity and mortality in CHF patients with LBBB.
Area of Science:
- Cardiology
- Heart Failure Research
- Echocardiography
Background:
- Left bundle branch block (LBBB) in chronic heart failure (CHF) is associated with poor systolic function, increased morbidity, and mortality.
- Data on LBBB's impact on diastolic function in CHF patients are limited.
Purpose of the Study:
- To determine the effect of LBBB on diastolic function in CHF patients.
- To assess LBBB's impact on left ventricular filling pressures and NT-proBNP levels in CHF.
Main Methods:
- 94 stable CHF patients (48 with LBBB, 46 without) underwent echocardiography and Doppler tissue analysis.
- Left ventricular filling pressures were estimated using the peak early mitral flow velocity to peak early diastolic mitral annular velocity ratio.
- N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured.
Main Results:
- Patients with LBBB showed shorter deceleration times and a more frequent restrictive mitral filling pattern compared to those without LBBB.
- The ratio of early mitral flow velocity to early diastolic mitral annular velocity was higher in LBBB patients, indicating elevated filling pressures.
- NT-proBNP levels were significantly higher in CHF patients with LBBB.
Conclusions:
- In CHF patients with similar systolic function, LBBB is associated with more severe diastolic dysfunction.
- LBBB correlates with elevated filling pressures and higher NT-proBNP levels in CHF.
- These findings suggest LBBB contributes to the increased morbidity and mortality observed in CHF patients.
Background:
For patients with chronic heart failure (CHF), left bundle branch block (LBBB) is associated with impaired systolic function and increased morbidity and mortality, but data on diastolic function are scarce. In this patient population, we attempted to define the impact of LBBB on diastolic function, filling pressures, and brain natriuretic peptide and its circulating N-terminal precursor (NT-proBNP) levels.
Methods:
A total of 94 patients with stable CHF (48 with complete LBBB, 46 without intraventricular conduction delay and normal QRS duration) underwent conventional 2-dimensional/Doppler echocardiography and Doppler tissue analysis of mitral annular velocities. As a measure of left ventricular filling pressures, the ratio of peak early mitral flow velocity to peak early diastolic mitral annular velocity was derived. NT-proBNP measurements were carried out on a bench-top analyzer (Elecsys-2010, Roche Diagnostics, Mannheim, Germany).
Results:
Patients with or without LBBB did not differ with respect to the cause of CHF or ejection fraction, but in LBBB deceleration time was shorter (163 +/- 66 vs 205 +/- 95 milliseconds, P = .021) and a restrictive mitral filling pattern was more frequent (35% vs 11%, P = .005). In such patients, the ratio of peak early mitral flow velocity to peak early diastolic mitral annular velocity was higher (14.5 +/- 6.2 vs 10.6 +/- 5.2, P < .001) and NT-proBNP was elevated (3553 +/- 3725 vs 850 +/- 896 pg/mL, P < .01) as compared with patients without LBBB.
Conclusion:
For patients with CHF and comparable systolic performance, LBBB is associated with more severe diastolic dysfunction, elevated filling pressures, and higher NT-proBNP levels. These findings may contribute to increased morbidity and mortality of such patients.
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