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Effects of left bundle branch block on echocardiographic coronary flow assessment: A systematic review

Davide Donelli1,2, Michele Antonelli3, Filippo Luca Gurgoglione1,2

  • 1Department of Medicine and Surgery, University of Parma, Parma, Italy.

Echocardiography (Mount Kisco, N.Y.)
|June 18, 2024
PubMed

Insights

Coronary flow reserve (CFR) assessed by echocardiography effectively identifies significant coronary artery disease (CAD) in patients with left bundle branch block (LBBB). This noninvasive method aids in risk stratification and clinical decision-making for this complex patient group.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Noninvasive Cardiovascular Assessment

Background:

  • Left bundle branch block (LBBB) complicates the assessment of coronary artery disease (CAD).
  • Coronary flow reserve (CFR) is a crucial indicator of myocardial perfusion.
  • Echocardiography offers a noninvasive approach to evaluate CFR.

Purpose of the Study:

  • To systematically review the diagnostic and prognostic utility of echocardiography-derived CFR in patients with LBBB.
  • To assess the impact of LBBB on CFR measurements and its correlation with CAD.
  • To evaluate CFR as a tool for risk stratification in LBBB patients.

Main Methods:

  • Systematic literature search of PubMed, EMBASE, Web of Science, Scopus, and Google Scholar up to March 2024.
  • Inclusion of six observational studies meeting PRISMA standards.
  • Analysis of echocardiographic CFR protocols in diverse LBBB populations.

Main Results:

  • Patients with LBBB and significant left anterior descending (LAD) artery stenosis showed significantly reduced stress-peak diastolic velocity and CFR compared to controls.
  • Pooled analysis indicated a marked decrease in CFR (MD = -0.60) in patients with significant LAD stenosis.
  • Echocardiographic CFR assessment demonstrated efficacy in identifying clinically significant CAD in the LBBB population.

Conclusions:

  • Echocardiography-based CFR assessment is a clinically relevant noninvasive tool for evaluating CAD in LBBB patients.
  • CFR measurement aids in cardiovascular risk stratification and guides clinical decisions in the presence of LBBB.
  • Standardization of CFR measurement protocols is needed for optimal application in LBBB patients.

Keywords:
LAD CFRLBBBcoronary flow reservedipyridamoleleft bundle branch blockstress echocardiography

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