Presence of contractile impairment appears crucial for structural remodeling in idiopathic left bundle-branch block

Journal of Cardiovascular Magnetic Resonance

Hauke Hund¹  Theresa Fischer¹  Marco Ochs²  Florian André²  Evangelos Giannitsis²  Matthias Müller-Hennessen²  Janek Salatzki²  Johannes Riffel²  Eberhard Scholz²  Norbert Frey²  Andreas Ochs²  Hugo A. Katus²  Matthias G. Friedrich³  Kristóf Hirschberg⁴ 

[1] Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany;Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany;DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany;Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany;DZHK (German Centre for Cardiovascular Research), Partner site Heidelberg, Heidelberg, Germany;Division of Cardiology, Departments of Medicine and Diagnostic Radiology, Mc-Gill University Health Centre, Montreal, Canada;Department of Cardiology, Angiology and Pneumology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany;Semmelweis University Heart and Vascular Center, Budapest, Hungary;

关键词: Left bundle-branch block;    Septal flash volume;    Fibrosis;    Remodeling;   

DOI  :  10.1186/s12968-021-00731-6

来源: Springer

【 摘 要 】

BackgroundTo differentiate effects of ventricular asynchrony from an underlying hypocontractile cardiomyopathy this study aimed to enhance the understanding of functional impairment and structural remodeling in idiopathic left bundle-branch block (LBBB).We hypothesize, that functional asynchrony with septal flash volume effects alone might not entirely explain the degree of functional impairment. Hence, we suggest the presence of a superimposed contractile cardiomyopathy.MethodsIn this retrospective study, 53 patients with idiopathic LBBB were identified and matched to controls with and without cardiovascular risk factors. Cardiovascular magnetic resonance (CMR) was used to evaluate cardiac function, volumes and myocardial fibrosis using native T1 mapping and late gadolinium enhancement (LGE). Septal flash volume was assessed by CMR volumetric measurements and allowed to stratify patients with systolic dysfunction solely due to isolated ventricular asynchrony or superimposed contractile impairment.ResultsReduced systolic LV-function, increased LV-volumes and septal myocardial fibrosis were found in patients with idiopathic LBBB compared to healthy controls. LV-volumes increased and systolic LV-function declined with prolonged QRS duration. Fibrosis was typically located at the right ventricular insertion points. Subgroups with superimposed contractile impairment appeared with pronounced LV dilation and increased fibrotic remodeling compared to individuals with isolated ventricular asynchrony.ConclusionsThe presence of superimposed contractile impairment in idiopathic LBBB is crucial to identify patients with enhanced structural remodeling. This finding suggests an underlying cardiomyopathy. Future studies are needed to assess a possible prognostic impact of this entity and the development of heart failure.Trial registration: This study was retrospectively registered.

【 授权许可】

CC BY