The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy

Cardiovascular Ultrasound

Peter Søgaard¹  Claus Graff²  Peter L. Sørensen²  Jacob M. Larsen³  Anna Margrethe Thøgersen³  Steen M. Hansen⁴  Brett D. Atwater⁵  Daniel J. Friedman⁵  Joseph Kisslo⁵  Kasper Emerek⁶  Niels Risum⁷ 

[1]0000 0001 0742 471X, grid.5117.2, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

[2]0000 0004 0646 7349, grid.27530.33, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

[3]0000 0001 0742 471X, grid.5117.2, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark

[4]0000 0004 0646 7349, grid.27530.33, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

[5]0000 0004 0646 7349, grid.27530.33, Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark

[6]0000000100241216, grid.189509.c, Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA

[7]0000000100241216, grid.189509.c, Department of Medicine, Division of Cardiology, Duke University Hospital, Durham, NC, USA

[8]0000 0001 0742 471X, grid.5117.2, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

[9]grid.475435.4, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark

关键词: Heart failure;    Left bundle branch block;    Cardiac resynchronization therapy;    Speckle-tracking echocardiography;   

DOI  :  10.1186/s12947-019-0160-4

来源: publisher

【 摘 要 】

BackgroundThe association of a Classical left bundle branch block (LBBB) contraction pattern and better outcome after cardiac resynchronization therapy (CRT) has only been studied using vendor-specific software for echocardiographic speckle-tracked longitudinal strain analysis. The purpose of this study was to assess whether a Classical LBBB contraction pattern on longitudinal strain analysis using vendor-independent software is associated with clinical outcome in CRT recipients with LBBB.MethodsThis was a retrospective cohort study including CRT recipients with LBBB, heart failure, and left ventricular (LV) ejection fraction ≤35%. Speckle-tracked echocardiographic longitudinal strain analysis was performed retrospectively on echocardiograms using vendor-independent software. The presence of a Classical LBBB contraction pattern was determined by consensus of two readers. The primary end point was a composite of time to death, heart transplantation or LV assist device implantation. Secondary outcome was ≥15% reduction in LV end-systolic volume. Intra- and inter-reader agreement of the longitudinal strain contraction pattern was assessed by calculating Cohen’s κ.ResultsOf 283 included patients, 113 (40%) were women, mean age was 66 ± 11 years, and 136 (48%) had ischemic heart disease. A Classical LBBB contraction pattern was present in 196 (69%). The unadjusted hazard ratio for reaching the primary end point was 1.93 (95% confidence interval, 1.36–2.76, p < 0.001) when comparing patients without to patients with a Classical LBBB contraction pattern. Adjusted for ischemic heart disease and QRS duration < 150 milliseconds the hazard ratio was 1.65 (95% confidence interval, 1.12–2.43, p = 0.01). Of the 123 (43%) patients with a follow-up echocardiogram, 64 of 85 (75%) of patients with a Classical LBBB contraction pattern compared to 13 of 38 (34%) without, had ≥15% reduction in LV end-systolic volume (p < 0.001). Cohen’s κ were 0.86 (95% confidence interval, 0.71–1.00) and 0.42 (95% confidence interval, 0.30–0.54) for intra- and inter-reader agreement, respectively.ConclusionUsing vendor-independent strain software, a Classical LBBB contraction pattern is associated with better outcome in CRT recipients with LBBB, but inter-reader agreement for the classification of contraction pattern is only moderate.

【 授权许可】

CC BY