4Dimensional XStrain Echocardiography assessment of Left Bundle Branch Cardiomyopathy in an elderly male : A case report
Keywords:
LBBB, left bundle branch block cardiomyopathy, systolic dysfunction, dyssynchrony cardiomyopathy
Abstract
Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns. Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it.
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References
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22. Dragulescu A, Grosse-Wortmann L, Fackoury C and Mertens L. Echocardiographic assessment to right ventricular volumes: a comparison of different techniques in children after surgical repair of tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2012; 13: 596-604.
23. Hwang IC, Cho GY, Yoon Y and Park J. Association between global longitudinal strain and cardiovascular events in patients with left bundle branch block assessed using two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. 2018;31:52–63.e6.
24. Park J.J., Park J.B., Park J.H., Cho G.Y. Global longitudinal strain to predict mortality in patient with acute heart failure. J Am Coll Cardiol. 2018;71:1947–1957.
25. Stankovic I, Prinz C, Ciarka A., Daraban AM, Kotrc M and Aarones M. Relationship of visually assessed apical rock and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT) Eur Heart J Cardiovasc Imaging. 2016;17:262–269.
26. Stankovic I, Belmans A, Prinz C, Ciarka A, Daraban AM and Kotrc M. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovascular Imaging. 2017;18:1109–1117.
27. Calle S, Kamoen., Buyzere MD, Pooter JD and Timmermans F. A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. J Am Coll Cardiol Img. 2021; 14:1691-1702.
28. Hwang IC, Cho GY, Yoon YE, Park JJ. Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography, Journal of the American Society of Echocardiography. 2018; 31:52-63.e6.
2. Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm. 2013; 10: 1932-1963.
3. Strauss DG, Selvester RH, Wagner GS. Defining left bundle branch block in the era of cardiac resynchronization therapy. Am J Cardiol. 2011;107:927– 934.
4. Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. Eur Heart J. 2005; 26: 2300.
5. Fahy GJ, Pinski SL, Miller DP, et al. Natural history of isolated bundle branch block. Am J Cardiol. 1996; 77: 1185-1190.
6. Imanishi R, Seto S, Ichimaru S, Nakashima E, Yano K, Akahoshi M. Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol. 2006; 98: 644-648.
7. Messer AL, Johnson RP, Shreenivas MD, White PD. Prognosis in bundle branch block. III. A comparison of right and left bundle branch block with a note on the relative incidence of each. Am Heart J. 1951; 41: 239-245.
8. Rabkin SW, Mathewson FAL, Tate RB. Natural history of left bundle-branch block. Br Heart J. 1980; 43: 164-169.
9. Breithardt O-A, Stellbrink C, Herbots L, et al. Cardiac resynchronization therapy can reverse abnormal myocardial strain distribution in patients with heart failure and left bundle branch block. J Am Coll Cardiol. 2003; 42: 486-494.
10. Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation. 1989; 79: 845-853.
11. Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361: 1329-1338.
12. Vaillant C, Martins RP, Donal E, et al. Resolution of left bundle branch block–induced cardiomyopathy by cardiac resynchronization therapy. J Am Coll Cardiol. 2013; 61: 1089-1095.
13. Braunschweig F. When cardiac function dangles on a thread of conduction. Dyssynchronopathy in patients with left bundle branch block. J Am Coll Cardiol. 2013; 61: 1096-1098.
14. Auffret V, Martins RP, Daubert C, et al. Idiopathic/iatrogenic left bundle branch block–induced reversible left ventricle dysfunction. J Am Coll Cardiol. 2018; 72: 3177-3188.
15. Rotman M, Triebwasser JH. A clinical and follow-up study of right and left bundle branch block Circulation. Circulation. 1975; 51:477–484.
16. Zhang ZM, Rautaharju PM, Soliman EZ, et al. Mortality risk associated with bundle branch blocks and related repolarization abnormalities (from the Women's Health Initiative [WHI]). Am J Cardiol. 2012; 110:1489–1495.
17. Blanc JJ, Fatemi M, Bertault V, Baraket F, Etienne Y. Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy Europace. 2005; 7:604–610.
18. Castellant P, Fatemi M, Orhan E, Etienne Y, Blanc JJ. Patients with non-ischaemic dilated cardiomyopathy and hyper-responders to cardiac resynchronization therapy: characteristics and long-term evolution. Europace. 2009; 11:350–355.
19. Muraru D, Niero A, Zanella HR, Cherata D and Badano LP. Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging. Cardiovasc Diagn Ther 2018; 8: 101-117.
20. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W and Voigt JU. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015; 16: 233-270.
21. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, Pedri S, Ito Y, Abe Y, Metz S, Song JH, Hamilton J, Sengupta PP, Kolias TJ, d'Hooge J, Aurigemma GP, Thomas JD and Badano LP. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. J Am Soc Echocardiogr 2015; 28: 183-193.
22. Dragulescu A, Grosse-Wortmann L, Fackoury C and Mertens L. Echocardiographic assessment to right ventricular volumes: a comparison of different techniques in children after surgical repair of tetralogy of Fallot. Eur Heart J Cardiovasc Imaging 2012; 13: 596-604.
23. Hwang IC, Cho GY, Yoon Y and Park J. Association between global longitudinal strain and cardiovascular events in patients with left bundle branch block assessed using two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. 2018;31:52–63.e6.
24. Park J.J., Park J.B., Park J.H., Cho G.Y. Global longitudinal strain to predict mortality in patient with acute heart failure. J Am Coll Cardiol. 2018;71:1947–1957.
25. Stankovic I, Prinz C, Ciarka A., Daraban AM, Kotrc M and Aarones M. Relationship of visually assessed apical rock and septal flash to response and long-term survival following cardiac resynchronization therapy (PREDICT-CRT) Eur Heart J Cardiovasc Imaging. 2016;17:262–269.
26. Stankovic I, Belmans A, Prinz C, Ciarka A, Daraban AM and Kotrc M. The association of volumetric response and long-term survival after cardiac resynchronization therapy. Eur Heart J Cardiovascular Imaging. 2017;18:1109–1117.
27. Calle S, Kamoen., Buyzere MD, Pooter JD and Timmermans F. A Strain-Based Staging Classification of Left Bundle Branch Block-Induced Cardiac Remodeling. J Am Coll Cardiol Img. 2021; 14:1691-1702.
28. Hwang IC, Cho GY, Yoon YE, Park JJ. Association Between Global Longitudinal Strain and Cardiovascular Events in Patients With Left Bundle Branch Block Assessed Using Two-Dimensional Speckle-Tracking Echocardiography, Journal of the American Society of Echocardiography. 2018; 31:52-63.e6.
How to Cite
1.
Mehrotra A, Mohammad Shaban, Ujala Shakya. 4Dimensional XStrain Echocardiography assessment of Left Bundle Branch Cardiomyopathy in an elderly male : A case report. Int J Med Res Rev [Internet]. 2024Feb.19 [cited 2024Dec.23];12(1):12-1. Available from: https://ijmrr.medresearch.in/index.php/ijmrr/article/view/1461
Section
Case Report
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