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Left ventricular twist was decreased in isolated left bundle branch block with preserved ejection fraction

Sabiye Yılmaz1, Harun Kılıc, Mustafa Tarık Ağac

  • 1Department of Cardiology, Faculty of Medicine, Sakarya University; Sakarya-Turkey. ssevincdr@gmail.com.

Anatolian Journal of Cardiology
|March 28, 2017
PubMed

Insights

Left bundle branch block (LBBB) significantly reduces left ventricular (LV) twist, a key measure of heart function, even when ejection fraction is normal. This finding suggests LV twist can detect subtle myocardial dysfunction in LBBB patients.

Area of Science:

  • Cardiology
  • Cardiac Mechanics
  • Echocardiography

Background:

  • Left ventricular (LV) rotation and twist are crucial for cardiac function.
  • Left bundle branch block (LBBB) is known to impair LV systolic and diastolic performance.
  • Subtle myocardial dysfunction may precede significant ejection fraction (EF) reduction in LBBB.

Purpose of the Study:

  • To evaluate LV twist in patients with LBBB and preserved EF.
  • To determine if LV twist can serve as an early marker for myocardial dysfunction in LBBB.
  • To compare LV twist between LBBB patients and healthy controls.

Main Methods:

  • Observational, cross-sectional study comparing 34 LBBB patients (preserved EF, no ischemic/valvular disease) with 36 healthy controls.
  • Utilized 2-D Doppler and 2-D speckle tracking echocardiography to assess LV apical, basal rotation, and twist.
  • Binary logistic regression analysis identified independent predictors of reduced LV twist.

Main Results:

  • LBBB patients exhibited significantly decreased mean apical rotation (2.5°±1.9° vs. 4.4°±2.9°), basal rotation (-2.9°±2.3° vs. -4.1°±2.7°), and LV twist (5.4°±3° vs. 8.6°±3.3°) compared to controls.
  • LBBB group showed higher indices of intra- and interventricular dyssynchrony.
  • Presence of LBBB was the sole independent predictor of reduced LV twist (OR=6.250; p<0.001).

Conclusions:

  • LBBB may reduce LV twist by impairing LV rotation before significantly affecting LVEF.
  • LV twist emerges as a sensitive marker for detecting subclinical LV dysfunction in LBBB patients with preserved EF.
  • Echocardiographic assessment of LV twist is valuable for early diagnosis of myocardial dysfunction in LBBB.
Abstract

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