A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling
Simon Calle1, Victor Kamoen1, Marc De Buyzere1
1Department of Cardiology, University Hospital Ghent, Ghent, Belgium.
JACC. Cardiovascular Imaging
|April 18, 2021
Summary
Left bundle branch block (LBBB) impacts left ventricular remodeling. This study identified four longitudinal strain patterns in LBBB patients, correlating with remodeling severity and potentially guiding treatment.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Left bundle branch block (LBBB) significantly alters left ventricular (LV) structure and function.
- Individual variability in LBBB-induced adverse cardiac remodeling is substantial.
- Understanding these remodeling patterns is crucial for patient management.
Purpose of the Study:
- To investigate the relationship between longitudinal strain patterns in LBBB and the degree of cardiac remodeling.
- To develop a staging system for LBBB-induced LV remodeling based on strain analysis.
- To assess the utility of strain patterns in evaluating LBBB's contribution to LV dysfunction.
Main Methods:
- Echocardiographic assessment, including speckle tracking strain analysis, was performed on 237 LBBB patients with septal flash (LBBB-SF).
- Four septal longitudinal strain patterns (LBBB-1 to LBBB-4) were identified and correlated with cardiac remodeling indices and extent of septal flash.
- Strain patterns were further analyzed in cardiac resynchronization therapy (CRT) super-responders and patients with acute LBBB.
Main Results:
- A higher LBBB stage correlated with increased LV volumes, reduced LV ejection fraction, longer QRS duration, and more pronounced septal flash.
- CRT super-responders showed a significant transition from higher strain stages (LBBB-3/4) to lower stages (LBBB-1/2) post-CRT.
- Patients with acute LBBB predominantly exhibited LBBB-1 or LBBB-2 patterns.
Conclusions:
- A novel classification of LBBB-induced LV remodeling based on longitudinal strain patterns is proposed.
- This classification may represent a pathophysiological continuum of LBBB-induced remodeling.
- The findings could aid in assessing LBBB's role in LV remodeling and dysfunction.
Keywords:
cardiac remodelingcardiac resynchronization therapyleft bundle branch blockseptal flashspeckle-tracking strainMore Related Videos
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