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Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study

BACKGROUND: A growing body of evidence suggests that the presence of a right bundle branch block (RBBB) is a negative prognostic indicator in patients with and without preexisting heart disease. Even though electromechanical activation of the right ventricle (RV) in patients with RBBB and pulmonary...

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Autores principales: Miller, Brian Edward, Rajsheker, Srinivas, López-Candales, Angel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738494/
https://www.ncbi.nlm.nih.gov/pubmed/26900418
http://dx.doi.org/10.4103/1995-705X.172197
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author Miller, Brian Edward
Rajsheker, Srinivas
López-Candales, Angel
author_facet Miller, Brian Edward
Rajsheker, Srinivas
López-Candales, Angel
author_sort Miller, Brian Edward
collection PubMed
description BACKGROUND: A growing body of evidence suggests that the presence of a right bundle branch block (RBBB) is a negative prognostic indicator in patients with and without preexisting heart disease. Even though electromechanical activation of the right ventricle (RV) in patients with RBBB and pulmonary hypertension (PH) has been investigated; a direct comparison of the presence of RBBB, on the duration of RV mechanical systole using echocardiography has not been studied. MATERIALS AND METHODS: In this retrospective study, we analyzed the echocardiograms of 40 patients by measuring the magnitude and timing of tricuspid annulus plane systolic excursion (TAPSE) and tricuspid annulus systolic velocity (TA S’). Patients were selected to form four groups of ten patients based on the presence or absence of RBBB and PH to determine if RBBB has any effect on the time-to-peak of TAPSE or TA S’, which for our purposes serves as a measure of duration of RV mechanical systole. RESULTS: Our results demonstrate that RBBB leads to a measurable prolongation of TAPSE and TA S’ in patients without PH. Time-to-peak of TAPSE or TA S’ was not significantly prolonged in patients with PH. CONCLUSIONS: The results of this pilot study show that RV mechanical systole is prolonged in patients with RBBB, and the addition of PH attenuates this change. Additional prospective studies are now required to elucidate further the electrical and mechanical dyssynchrony that occurs as a result of RBBB, and how these new echocardiographic measurements can be applied clinically to risk stratify patients with RBBB and PH.
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spelling pubmed-47384942016-02-19 Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study Miller, Brian Edward Rajsheker, Srinivas López-Candales, Angel Heart Views Original Article BACKGROUND: A growing body of evidence suggests that the presence of a right bundle branch block (RBBB) is a negative prognostic indicator in patients with and without preexisting heart disease. Even though electromechanical activation of the right ventricle (RV) in patients with RBBB and pulmonary hypertension (PH) has been investigated; a direct comparison of the presence of RBBB, on the duration of RV mechanical systole using echocardiography has not been studied. MATERIALS AND METHODS: In this retrospective study, we analyzed the echocardiograms of 40 patients by measuring the magnitude and timing of tricuspid annulus plane systolic excursion (TAPSE) and tricuspid annulus systolic velocity (TA S’). Patients were selected to form four groups of ten patients based on the presence or absence of RBBB and PH to determine if RBBB has any effect on the time-to-peak of TAPSE or TA S’, which for our purposes serves as a measure of duration of RV mechanical systole. RESULTS: Our results demonstrate that RBBB leads to a measurable prolongation of TAPSE and TA S’ in patients without PH. Time-to-peak of TAPSE or TA S’ was not significantly prolonged in patients with PH. CONCLUSIONS: The results of this pilot study show that RV mechanical systole is prolonged in patients with RBBB, and the addition of PH attenuates this change. Additional prospective studies are now required to elucidate further the electrical and mechanical dyssynchrony that occurs as a result of RBBB, and how these new echocardiographic measurements can be applied clinically to risk stratify patients with RBBB and PH. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4738494/ /pubmed/26900418 http://dx.doi.org/10.4103/1995-705X.172197 Text en Copyright: © Heart Views http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Miller, Brian Edward
Rajsheker, Srinivas
López-Candales, Angel
Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title_full Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title_fullStr Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title_full_unstemmed Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title_short Right Bundle Branch Block and Electromechanical Coupling of the Right Ventricle: An Echocardiographic Study
title_sort right bundle branch block and electromechanical coupling of the right ventricle: an echocardiographic study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738494/
https://www.ncbi.nlm.nih.gov/pubmed/26900418
http://dx.doi.org/10.4103/1995-705X.172197
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