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Related Experiment Video

Updated: Sep 20, 2025

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Strain-based staging as a unifying concept in cardiac resynchronization therapy.

Jürgen Duchenne1,2,3,4, Simon Calle5, Ivan Stankovic6

  • 1Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.

European Heart Journal. Cardiovascular Imaging
|May 26, 2025
PubMed
Summary

Left bundle branch block (LBBB) septal strain patterns predict cardiac resynchronization therapy (CRT) outcomes. Lower strain stages indicate reduced benefits, potentially due to myocardial scar, highlighting LBBB patterns for personalized CRT.

Keywords:
cardiac remodellingcardiac resynchronization therapyleft bundle branch blockmechanical dyssynchronyspeckle-tracking strain

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Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Medical Imaging

Background:

  • Left bundle branch block (LBBB) septal strain patterns are linked to left ventricular (LV) reverse remodeling post-cardiac resynchronization therapy (CRT).
  • The prognostic value of LBBB strain patterns and their impact on CRT outcomes, including comparison with conservative treatment, requires further investigation.
  • Understanding the interplay between LBBB strain patterns, myocardial scar, and CRT response is crucial for optimizing patient selection and treatment strategies.

Purpose of the Study:

  • To validate the prognostic significance of LBBB septal strain patterns in patients undergoing CRT.
  • To investigate the impact of LBBB strain patterns on clinical outcomes and volumetric response in CRT recipients.
  • To explore the relationship between LBBB strain patterns, myocardial scar burden, and CRT efficacy in CRT-eligible patients receiving conservative treatment.

Main Methods:

  • A multicentre study involving 267 CRT patients who underwent pre-implantation speckle-tracking strain analysis.
  • Cardiac magnetic resonance imaging was performed in 155 CRT patients to assess myocardial scar.
  • Comparison between CRT-treated patients and 116 CRT-eligible conservatively treated patients, categorizing LBBB septal strain curves into five stages (LBBB-0 to LBBB-4).

Main Results:

  • A stepwise improvement in volumetric response and survival was observed across LBBB stages in CRT recipients (P < 0.001 and P = 0.002, respectively).
  • Myocardial scar, present in 52% of CRT patients, showed an inverse correlation with LBBB stages (P = 0.003).
  • LBBB stages independently predicted volumetric response (OR 2.30, P < 0.001) and survival (HR 0.64, P = 0.038), whereas scar burden did not. Survival benefits were significantly greater in CRT-treated versus conservatively treated patients, especially in higher LBBB stages.

Conclusions:

  • LBBB septal strain stages serve as independent predictors of CRT outcomes.
  • Lower LBBB strain stages are associated with attenuated CRT benefits, potentially mediated by higher myocardial scar burden.
  • This LBBB strain classification offers a valuable framework for understanding LBBB pathophysiology and optimizing CRT response.