Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar
Publication year
2018Source
Journal of Electrocardiology, 51, 6, (2018), pp. 1071-1076ISSN
Publication type
Article / Letter to editor

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Organization
Cardiology
Journal title
Journal of Electrocardiology
Volume
vol. 51
Issue
iss. 6
Page start
p. 1071
Page end
p. 1076
Subject
Radboudumc 16: Vascular damage RIHS: Radboud Institute for Health SciencesAbstract
INTRODUCTION: The relationship between left ventricular (LV) ejection fraction (EF) and LV myocardial scar can identify potentially reversible causes of LV dysfunction. Left bundle branch block (LBBB) alters the electrical and mechanical activation of the LV. We hypothesized that the relationship between LVEF and scar extent is different in LBBB compared to controls. METHODS: We compared the relationship between LVEF and scar burden between patients with LBBB and scar (n=83), and patients with chronic ischemic heart disease and scar but no electrocardiographic conduction abnormality (controls, n=90), who had undergone cardiovascular magnetic resonance (CMR) imaging at one of three centers. LVEF (%) was measured in CMR cine images. Scar burden was quantified by CMR late gadolinium enhancement (LGE) and expressed as % of LV mass (%LVM). Maximum possible LVEF (LVEFmax) was defined as the function describing the hypotenuse in the LVEF versus myocardial scar extent scatter plot. Dysfunction index was defined as LVEFmax derived from the control cohort minus the measured LVEF. RESULTS: Compared to controls with scar, LBBB with scar had a lower LVEF (median [interquartile range] 27 [19-38] vs 36 [25-50] %, p<0.001), smaller scar (4 [1-9] vs 11 [6-20] %LVM, p<0.001), and greater dysfunction index (39 [30-52] vs 21 [12-35] % points, p<0.001). CONCLUSIONS: Among LBBB patients referred for CMR, LVEF is disproportionately reduced in relation to the amount of scar. Dyssynchrony in LBBB may thus impair compensation for loss of contractile myocardium.
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- Academic publications [227727]
- Faculty of Medical Sciences [86204]
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