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Comparison of Left Ventricular Torsion and Strain With Biventricular Pacing in Patients With Underlying Right Bundle Branch Block Versus Those With Left Bundle Branch Block

Published:January 16, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.01.018
      The benefits of biventricular pacing in patients with cardiac resynchronization therapy (CRT) remain poorly understood in those with right bundle branch block (RBBB). The aim of this study was to examine the differences in several speckle tracking–derived parameters, including left ventricular torsion and longitudinal strain with CRT on and off for patients with underlying left bundle branch block (LBBB) and RBBB. Twelve patients with CRT and RBBB were compared with a similar group of patients with underlying LBBB who were sent for evaluation and atrioventricular optimization. Echocardiographic images were acquired with biventricular pacing on and off. The 2 groups had similar baseline characteristics, including age, the ejection fraction, and QRS duration. During intrinsic conduction (CRT off), patients with LBBB had lower torsion angles than those with RBBB (2.3 ± 1.0° in those with LBBB vs 6.3 ± 1.0° in those with RBBB, p = 0.03) but trended toward improvements in torsional parameters, including torsional angle and peak untwisting velocity with CRT on, whereas these parameters worsened in patients with RBBB. Compared with CRT off, analyses of septal and lateral strain curves showed significant improvements in septal strain during 100% and 200% of systole with CRT on in patients with LBBB, whereas biventricular pacing resulted in a trend toward worsening of septal strain in patients with RBBB. Negligible changes were noted in lateral strain values. In conclusion, CRT favorably improves regional mechanics in patients with LBBB primarily involving the ventricular septum, with a negligible positive impact on cardiac function in patients with underlying RBBB.
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      References

        • Popovic Z.
        • Benejam C.
        • Bian J.
        • Mal N.
        • Drinko J.
        • Lee K.
        • Forudi F.
        • Reeg R.
        • Greenberg N.
        • Thomas J.
        • Penn M.
        Speckle-tracking echocardiography correctly identifies segmental left ventricular dysfunction induced by scarring in a rat model of myocardial infarction.
        Am J Physiol Heart Circ Physiol. 2007; 292: H2809-H2816
        • Willems J.
        • Robles de Medina E.
        • Bernard R.
        • Coumel P.
        • Fisch C.
        • Krikler D.
        • Mazur N.
        • Meijler F.
        • Mogensen L.
        • Moret P.
        Criteria for intraventricular conduction disturbances and pre-excitation. World Health Organizational/International Society and Federation for Cardiology Task Force Ad Hoc.
        J Am Coll Cardiol. 1985; 5: 1261-1275
        • Lang R.
        • Bierig M.
        • Devereux R.
        • Flachskampf F.
        • Foster E.
        • Pellikka P.
        • Picard M.
        • Roman M.
        • Seward J.
        • Shanewise J.
        • Solomon S.
        • Spencer K.
        • Sutton M.
        • Stewart W.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • Schiller N.
        • Shah P.
        • Crawford M.
        • DeMaria A.
        • Devereux R.
        • Feigenbaum H.
        • Gutgesell H.
        • Reichek N.
        • Sahn D.
        • Schnittger I.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Mullens W.
        • Grimm R.
        • Verga T.
        • Dresing T.
        • Starling R.C.
        • Wilkoff B.
        • Tang W.
        Insights from a cardiac resynchronization optimization clinic as part of a heart failure disease management program.
        J Am Coll Cardiol. 2009; 53: 765-773
        • Mullens W.
        • Tang W.
        • Grimm R.
        Using echocardiography in cardiac resynchronization therapy.
        Am Heart J. 2007; 154: 1011-1020
        • Gorcsan J.
        • Abraham T.
        • Agler D.
        • Bax J.
        • Derumeaux G.
        • Grimm R.
        • Martin R.
        • Steinberg J.
        • Sutton M.
        • Yu C.
        Echocardiography for cardiac resynchronization therapy: recommendations for performance and reporting—a report from the American Society of Echocardiography Dyssynchrony Writing Group endorsed by the Heart Rhythm Society.
        J Am Soc Echocardiogr. 2008; 21: 191-213
        • Lim P.
        • Buakhamsri A.
        • Popovic Z.
        • Greenberg N.
        • Patel D.
        • Thomas J.
        • Grimm R.
        Longitudinal strain delay index by speckle tracking imaging: a new marker of response to cardiac resynchronization therapy.
        Circulation. 2008; 118: 1130-1137
        • Mullens W.
        • Borowski A.G.
        • Curtin R.
        • Grimm R.
        • Thomas J.
        • Tang W.
        Mechanical dyssynchrony in advanced decompensated heart failure: relation to hemodynamic responses to intensive medical therapy.
        Heart Rhythm. 2008; 5: 1105-1110
        • Badano L.
        • Gaddi O.
        • Peraldo C.
        • Lupi G.
        • Sitges M.
        • Parthenakis F.
        • Molteni S.
        • Pagliuca M.
        • Sassone B.
        • Di Stefano P.
        • De Santo T.
        • Menozzi C.
        • Brignole M.
        Left ventricular electromechanical delay in patients with heart failure and normal QRS duration and in patients with right and left bundle branch block.
        Europace. 2007; 9: 41-47
        • Haghjoo M.
        • Bagherzadeh A.
        • Farahani M.
        • Haghighi Z.
        • Sadr-Ameli M.
        Significance of QRS morphology in determining the prevalence of mechanical dyssynchrony in heart failure patients eligible for cardiac resynchronization: particular focus on patients with right bundle branch block with and without coexistent left-sided conduction defects.
        Europace. 2008; 10: 566-571