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True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography

BACKGROUND: Conventional complete left bundle branch block (CLBBB) criteria sometimes result in a false‐positive diagnosis that does not represent dyssynchrony. Recently, true CLBBB criteria have been proposed to detect responders to cardiac resynchronization therapy (CRT), although their correlatio...

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Autores principales: Iiya, Munehiro, Shimizu, Masato, Fujii, Hiroyuki, Suzuki, Makoto, Nishizaki, Mitsuhiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373645/
https://www.ncbi.nlm.nih.gov/pubmed/30805046
http://dx.doi.org/10.1002/joa3.12148
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author Iiya, Munehiro
Shimizu, Masato
Fujii, Hiroyuki
Suzuki, Makoto
Nishizaki, Mitsuhiro
author_facet Iiya, Munehiro
Shimizu, Masato
Fujii, Hiroyuki
Suzuki, Makoto
Nishizaki, Mitsuhiro
author_sort Iiya, Munehiro
collection PubMed
description BACKGROUND: Conventional complete left bundle branch block (CLBBB) criteria sometimes result in a false‐positive diagnosis that does not represent dyssynchrony. Recently, true CLBBB criteria have been proposed to detect responders to cardiac resynchronization therapy (CRT), although their correlation with severity of dyssynchrony or natural prognosis is unclear. METHODS: Ninety‐four consecutive patients (74 ± 9 years, 63 men) with conventional CLBBB during sinus rhythm underwent semiconductor SPECT. They were divided into two groups: patients with true CLBBB and others. True CLBBB was characterized by the mid‐QRS notching/slurring and wide QRS duration (male, ≥140 milliseconds; female, ≥130 milliseconds). Multivariate analysis was performed to detect left ventricular dyssynchrony (LVD), defined as bandwidth ≥145° and/or phase standard deviation (SD) ≥43°. Primary endpoints (hospitalization for heart failure or cardiac death) were evaluated. RESULTS: True CLBBB had wider bandwidth (145 ± 83° vs 110 ± 64°, P = 0.024) and higher phase SD (48 ± 26° vs 35 ± 19°, P = 0.007). Ejection fraction (EF), end‐diastolic volume (EDV), summed rest score (SRS), and the presence of ischemic heart disease (IHD) showed no differences between groups (P = 0.401, 0.591, 0.165, and 0.212, respectively). Multivariate analysis revealed that true CLBBB, EF, and EDV were significant predictors of LVD (odds ratio, 12.6, 0.90, 1.03; P = 0.003, 0.002, 0.022, respectively). At 3‐year follow‐up (median 667 days), primary endpoints were comparable in both groups (log‐rank, P = 0.92). CONCLUSIONS: Patients with true CLBBB had more severe dyssynchrony on single‐photon emission computed tomography than patients with nontrue CLBBB. On the other hand, the two groups showed no differences in EF, EDV, the presence of IHD, hospitalization for heart failure, and cardiac death.
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spelling pubmed-63736452019-02-25 True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography Iiya, Munehiro Shimizu, Masato Fujii, Hiroyuki Suzuki, Makoto Nishizaki, Mitsuhiro J Arrhythm Original Articles BACKGROUND: Conventional complete left bundle branch block (CLBBB) criteria sometimes result in a false‐positive diagnosis that does not represent dyssynchrony. Recently, true CLBBB criteria have been proposed to detect responders to cardiac resynchronization therapy (CRT), although their correlation with severity of dyssynchrony or natural prognosis is unclear. METHODS: Ninety‐four consecutive patients (74 ± 9 years, 63 men) with conventional CLBBB during sinus rhythm underwent semiconductor SPECT. They were divided into two groups: patients with true CLBBB and others. True CLBBB was characterized by the mid‐QRS notching/slurring and wide QRS duration (male, ≥140 milliseconds; female, ≥130 milliseconds). Multivariate analysis was performed to detect left ventricular dyssynchrony (LVD), defined as bandwidth ≥145° and/or phase standard deviation (SD) ≥43°. Primary endpoints (hospitalization for heart failure or cardiac death) were evaluated. RESULTS: True CLBBB had wider bandwidth (145 ± 83° vs 110 ± 64°, P = 0.024) and higher phase SD (48 ± 26° vs 35 ± 19°, P = 0.007). Ejection fraction (EF), end‐diastolic volume (EDV), summed rest score (SRS), and the presence of ischemic heart disease (IHD) showed no differences between groups (P = 0.401, 0.591, 0.165, and 0.212, respectively). Multivariate analysis revealed that true CLBBB, EF, and EDV were significant predictors of LVD (odds ratio, 12.6, 0.90, 1.03; P = 0.003, 0.002, 0.022, respectively). At 3‐year follow‐up (median 667 days), primary endpoints were comparable in both groups (log‐rank, P = 0.92). CONCLUSIONS: Patients with true CLBBB had more severe dyssynchrony on single‐photon emission computed tomography than patients with nontrue CLBBB. On the other hand, the two groups showed no differences in EF, EDV, the presence of IHD, hospitalization for heart failure, and cardiac death. John Wiley and Sons Inc. 2018-12-20 /pmc/articles/PMC6373645/ /pubmed/30805046 http://dx.doi.org/10.1002/joa3.12148 Text en © 2018 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Iiya, Munehiro
Shimizu, Masato
Fujii, Hiroyuki
Suzuki, Makoto
Nishizaki, Mitsuhiro
True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title_full True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title_fullStr True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title_full_unstemmed True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title_short True complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
title_sort true complete left bundle branch block reveals dyssynchrony evaluated by semiconductor single‐photon emission computed tomography
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6373645/
https://www.ncbi.nlm.nih.gov/pubmed/30805046
http://dx.doi.org/10.1002/joa3.12148
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