Related Experiment Video
Updated: Jul 5, 2025
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Association between left bundle branch block and ventricular septal mid-wall fibrosis in patients with preserved left
Xiaojie Liu1, Muzhang Li2, Jiaying Chen2
1Department of Cardiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, China.
Insights
Left bundle branch block (LBBB) is linked to septal mid-wall fibrosis (SMF) in patients with preserved ejection fraction. A resting ECG can help identify patients at high risk for SMF.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Cardiovascular Imaging
Background:
- Left bundle branch block (LBBB) is known to associate with septal mid-wall fibrosis (SMF) in dilated cardiomyopathy (DCM).
- The association between LBBB and SMF in patients with preserved left ventricular ejection fraction (LVEF) is not well-established.
Purpose of the Study:
- To investigate the relationship between LBBB and SMF in patients with preserved LVEF.
- To determine if LBBB can serve as a predictor for SMF in this patient population.
Main Methods:
- Retrospective analysis of 210 patients with preserved LVEF.
- LBBB diagnosis based on QRS duration and specific ECG criteria.
- SMF assessment using late gadolinium-enhancement cardiovascular magnetic resonance (LGE-CMR).
Main Results:
- Septal mid-wall fibrosis (SMF) was detected in 24.8% of patients.
- Patients with LBBB had a significantly higher prevalence of SMF (58.3% vs. 20.4%, P < 0.001).
- LBBB was independently associated with SMF (OR, 4.399; P = 0.001), with high specificity (94%) for SMF detection.
Conclusions:
- LBBB is significantly associated with SMF in hospitalized patients with preserved LVEF.
- Resting 12-lead ECG screening may identify patients at high risk for SMF.
- LBBB presence on ECG can aid in risk stratification for SMF in patients with preserved LVEF.
Background:
The left bundle branch block (LBBB) is associated with ventricular septal mid-wall fibrosis (SMF) in patients with dilated cardiomyopathy (DCM). However, whether LBBB is also associated with SMF in patients with preserved left ventricular ejection fraction (LVEF) remains unclear.
Methods:
We performed a retrospective study of 210 patients with preserved LVEF (male, n = 116; female, n = 94; mean age, 44 ± 17 years). LBBB was defined as QRS duration ≥140 ms for men or ≥ 130 ms for women, QS or rS in V1-V2, mid-QRS notching or slurring in at least two leads (V1, V2, V5, V6, I, and aVL). SMF determined by late gadolinium-enhancement cardiovascular magnetic resonance was defined as stripe-like or patchy mid-myocardial hyper-enhancement in the interventricular septal segments.
Results:
SMF was detected in 24.8% (52/210) of these patients. The proportion of patients with SMF with LBBB was higher than the proportion of patients with SMF without LBBB (58.3% vs. 20.4%; P < 0.001). In the forward multivariate logistic analysis, LBBB (OR, 4.399; 95% CI, 1.774-10.904; P = 0.001) and age (OR, 1.028; 95% CI, 1.006-1.051; P = 0.011) were independently associated with SMF. The presence of LBBB showed a sensitivity of 27%%, specificity of 94%, positive predictive value of 58%%, and negative predictive value of 80% for the detection of SMF.
Conclusion:
LBBB was significantly associated with SMF in hospitalized patients with preserved LVEF. Screening with a resting 12‑lead ECG may help to identify patients who are at a high risk of the presence of SMF.
