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Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Temporal Changes in Left Ventricular Strain in Typical and Atypical Left Bundle Branch Block Patients: A Follow-up
Abhishek K Shetty1, Mukund A Prabhu2, Krishnananda Nayak1
1Department of Cardiovascular Technology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Insights
Left bundle branch block (LBBB) can lead to heart remodeling and poor prognosis. Age, reduced ejection fraction (ALEF), and global longitudinal strain (GLS) predict mortality in LBBB patients.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Echocardiography
Background:
- Left bundle branch block (LBBB) alters left ventricular (LV) activation, causing remodeling, dysfunction, and poor prognosis.
- Ventricular remodeling in LBBB typically involves LV hypertrophy and dilatation.
- LBBB is associated with progressive cardiac dysfunction.
Purpose of the Study:
- To compare temporal changes in left ventricular strain patterns in patients with typical and atypical LBBB.
- To evaluate predictors of mortality in LBBB patients over a two-year period.
Main Methods:
- Prospective enrollment of patients with LBBB.
- Two-year follow-up including electrocardiographic and echocardiographic assessments.
- Analysis of left ventricular strain parameters, including global longitudinal strain (GLS).
Main Results:
- A two-year all-cause mortality rate of 13.8% was observed in LBBB patients.
- Age, reduced ejection fraction (ALEF ≤40%), and GLS were significant independent predictors of mortality.
- Improvements in LV function and ventricular dyssynchrony were noted during follow-up.
Conclusions:
- Mortality in LBBB patients is predicted by age, ALEF, and GLS.
- While LV function and dyssynchrony improved, the drivers of these changes remain undetermined.
- Further research is needed to elucidate factors influencing LBBB patient outcomes.
Introduction:
Left bundle branch block (LBBB) is a conduction abnormality that alters the pattern of left ventricular (LV) activation and contraction, leading to ventricular remodeling, typically manifesting as LV hypertrophy and dilatation. This remodeling is often associated with progressive cardiac dysfunction and a poor prognosis.
Aim:
To compare temporal changes in left ventricular strain patterns in patients with typical and atypical LBBB over a period of two years.
Methods:
Electrocardiographic, echocardiographic, and strain parameters were obtained at two-year follow-up from previously enrolled patients.
Results:
Of the 181 patients initially enrolled, 152 were contacted telephonically. Among them, 23 patients underwent follow-up evaluation, 4 patients received cardiac resynchronization therapy (CRT), and 21 deaths were recorded. Significant changes between baseline and follow-up were observed in left ventricular end-diastolic dimension (LVEDD), left ventricular filling time (LVFT), LVFT/R-R interval, three-dimensional systolic dyssynchrony index (SDI), and left ventricular ejection fraction (EF). Compared with survivors, non-survivors had significantly lower baseline EF, and global longitudinal strain (GLS). An ALEF ≤40% was identified as a significant predictor of mortality. Multivariable regression analysis demonstrated that ALEF, GLS, and age were independent predictors of mortality.
Conclusion:
The all-cause mortality rate over two years among patients with LBBB was 13.8%. Age, ALEF, and GLS were significant predictors of mortality. Improvements in left ventricular function and ventricular dyssynchrony were observed during follow-up; however, the factors contributing to these changes could not be determined from the present study.
Trial Registration:
Clinical Trials Registry-India on 02/05/2023 under the reference number CTRI/2023/05/052206.
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