Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar

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Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar. / Axelsson, Jimmy; Wieslander, Björn; Jablonowski, Robert; Klem, Igor; Nijveldt, Robin; Schelbert, Erik B.; Sörensson, Peder; Sigfridsson, Andreas; Chaudhry, Uzma; Platonov, Pyotr G.; Borgquist, Rasmus; Engblom, Henrik; Strauss, David G.; Arheden, Håkan; Atwater, Brett D.; Ugander, Martin.

I: Journal of Electrocardiology, Vol. 51, Nr. 6, 2018, s. 1071-1076.

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Axelsson, Jimmy ; Wieslander, Björn ; Jablonowski, Robert ; Klem, Igor ; Nijveldt, Robin ; Schelbert, Erik B. ; Sörensson, Peder ; Sigfridsson, Andreas ; Chaudhry, Uzma ; Platonov, Pyotr G. ; Borgquist, Rasmus ; Engblom, Henrik ; Strauss, David G. ; Arheden, Håkan ; Atwater, Brett D. ; Ugander, Martin. / Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar. I: Journal of Electrocardiology. 2018 ; Vol. 51, Nr. 6. s. 1071-1076.

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TY - JOUR

T1 - Ejection fraction in left bundle branch block is disproportionately reduced in relation to amount of myocardial scar

AU - Axelsson, Jimmy

AU - Wieslander, Björn

AU - Jablonowski, Robert

AU - Klem, Igor

AU - Nijveldt, Robin

AU - Schelbert, Erik B.

AU - Sörensson, Peder

AU - Sigfridsson, Andreas

AU - Chaudhry, Uzma

AU - Platonov, Pyotr G.

AU - Borgquist, Rasmus

AU - Engblom, Henrik

AU - Strauss, David G.

AU - Arheden, Håkan

AU - Atwater, Brett D.

AU - Ugander, Martin

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Left bundle branch block

KW - Left ventricular ejection fraction

KW - Magnetic resonance imaging

KW - Myocardial scarring

UR - https://doi.org/10.1016/j.jelectrocard.2019.01.082

U2 - 10.1016/j.jelectrocard.2018.09.009

DO - 10.1016/j.jelectrocard.2018.09.009

M3 - Article

VL - 51

SP - 1071

EP - 1076

JO - Journal of Electrocardiology

T2 - Journal of Electrocardiology

JF - Journal of Electrocardiology

SN - 1532-8430

IS - 6

ER -