Myocardial work and energy loss of left ventricle obtained by pressure-strain loop and vector flow mapping: a new perspective on idiopathic left bundle branch block

BACKGROUND: To date, no research has been conducted on the electrical activity and mechanical dyssynchrony of idiopathic left bundle branch block (iLBBB) with normal left ventricular ejection fraction (LVEF). This study sought to assess the left ventricular summation of energy loss (EL-SUM) and average energy loss (EL-AVE) using vector flow mapping as well as myocardial work using pressure-strain loop (PSL) in patients with iLBBB and normal LVEF. METHODS: We prospectively recruited 35 patients with iLBBB and 35 control participants with normal LVEF. Echocardiography was performed. Conventional echocardiographic parameters, myocardial work, and energy loss (i.e., the EL-SUM and EL-AVE) were calculated. RESULTS: In relation to global myocardial work, compared to the control participants, the iLBBB patients showed decreased global longitudinal strain (GLS; –15.32%±2.58% vs. –18.27%±2.12%; P=0.001), a decreased global work index (GWI; 1,428.24±338.18 vs. 1,964.87±264.16 mmHg%; P<0.001), decreased global work efficiency (GWE) (84.48±5.19 vs. 91.73±5.31 mmHg%; P<0.001), and significantly increased global waste work (GWW; 341.60±132.62 vs. 161.80±106.81 mmHg%; P<0.001). In relation to the regional index, the iLBBB patients had a significantly reduced basal anteroseptal segment (879.15±370.50 vs. 1,746.38±154.44 mmHg%; P<0.001), basal inferoseptal segment (1,111.42±389.04 vs. 1,677.25±223.10 mmHg%; P<0.001), mid-anteroseptal segment (1,097.54±394.83 vs. 1,815.06±291.22 mmHg%; P<0.001), mid-inferoseptal segment (1,012.54±353.33 vs. 1,880.88±254.39 mmHg%; P<0.001), apical anterior segment (1,592.42±366.64 vs. 1,910.00±170.27 mmHg%; P=0.001), apical lateral segment (1,481.62±342.95 vs. 1,817.19±227.55 mmHg%; P=0.001), apical septal segment (1,437.65±428.22 vs. 1,852.25±275.19 mmHg%; P=0.001), and apex (1,542.62±342.89 vs. 1,907.06±197.94 mmHg%; P<0.001). The iLBBB patients had increased EL-AVE and EL-SUM during the late-diastole, isovolumic-systole, and rapid-ejection periods [EL-AVE in T2: 28.3 (8.7, 49.0) vs. 6.8 (5.4, 9.4) J/(s·m(3)); P=0.029]; [EL-AVE in T3: 24.7 (13.0, 46.8) vs. 7.2 (5.4, 10.8) J/(s·m(3)), P<0.001]; [EL-AVE in T4: 18.3 (12.0, 27.6) vs. 7.7 (4.1, 11.6) J/(s·m(3)), P=0.002]; [EL-SUM in T2: 8.3 (2.2, 14.5) vs. 2.1 (1.6, 3.2) J/(s·m), P=0.049]; [EL-SUM in T3: 7.6 (4.0, 14.5) vs. 2.2 (1.7, 3.3) J/(s·m), P<0.001]; [EL-SUM in T4: 5.3 (3.6, 9.7) vs. 2.2 (1.4, 3.0) J/(s·m), P=0.004]. CONCLUSIONS: The GWI and GWE were reduced in patients with iLBBB, especially in the septum and apex. The EL-SUM and EL-AVE were higher in patients with iLBBB during the late-diastole, isovolumic-systole, and rapid-ejection periods. EL and PSL reflect the LV hemodynamics of patients with iLBBB.