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Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony

Background: The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB (“longitudinal rotation”). Aim: The aim of this study was to...

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Autores principales: Marai, Ibrahim, Haddad, Rabea, Andria, Nizar, Kinany, Wadi, Hazanov, Yevgeni, Kleinberg, Bruce M., Birati, Edo, Carasso, Shemy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917432/
https://www.ncbi.nlm.nih.gov/pubmed/36769391
http://dx.doi.org/10.3390/jcm12030745
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author Marai, Ibrahim
Haddad, Rabea
Andria, Nizar
Kinany, Wadi
Hazanov, Yevgeni
Kleinberg, Bruce M.
Birati, Edo
Carasso, Shemy
author_facet Marai, Ibrahim
Haddad, Rabea
Andria, Nizar
Kinany, Wadi
Hazanov, Yevgeni
Kleinberg, Bruce M.
Birati, Edo
Carasso, Shemy
author_sort Marai, Ibrahim
collection PubMed
description Background: The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB (“longitudinal rotation”). Aim: The aim of this study was to quantify the “longitudinal rotation” of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB). Methods: Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac–Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis—mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The “posterior” segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded. Results: All patients with CLBBB (n = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of −3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (−1.4 ± 3°, p = 0.005) and CRBBB (0.1 ± 2.2°, p = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities. Conclusions: Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography.
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spelling pubmed-99174322023-02-11 Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony Marai, Ibrahim Haddad, Rabea Andria, Nizar Kinany, Wadi Hazanov, Yevgeni Kleinberg, Bruce M. Birati, Edo Carasso, Shemy J Clin Med Article Background: The complete left bundle branch block (CLBBB) results in ventricular dyssynchrony and a reduction in systolic and diastolic efficiency. We noticed a distinct clockwise rotation of the left ventricle (LV) in patients with CLBBB (“longitudinal rotation”). Aim: The aim of this study was to quantify the “longitudinal rotation” of the LV in patients with CLBBB in comparison to patients with normal conduction or complete right bundle branch block (CRBBB). Methods: Sixty consecutive patients with normal QRS, CRBBB, or CLBBB were included. Stored raw data DICOM 2D apical-4 chambers view images cine clips were analyzed using EchoPac plugin version 203 (GE Vingmed Ultrasound AS, Horten, Norway). In EchoPac–Q-Analysis, 2D strain application was selected. Instead of apical view algorithms, the SAX-MV (short axis—mitral valve level) algorithm was selected for analysis. A closed loop endocardial contour was drawn to initiate the analysis. The “posterior” segment (representing the mitral valve) was excluded before finalizing the analysis. Longitudinal rotation direction, peak angle, and time-to-peak rotation were recorded. Results: All patients with CLBBB (n = 21) had clockwise longitudinal rotation with mean four chamber peak rotation angle of −3.9 ± 2.4°. This rotation is significantly larger than in patients with normal QRS (−1.4 ± 3°, p = 0.005) and CRBBB (0.1 ± 2.2°, p = 0.00001). Clockwise rotation was found to be correlated to QRS duration in patients with the non-RBBB pattern. The angle of rotation was not associated with a lower ejection fraction or the presence of regional wall abnormalities. Conclusions: Significant clockwise longitudinal rotation was found in CLBBB patients compared to normal QRS or CRBBB patients using speckle-tracking echocardiography. MDPI 2023-01-17 /pmc/articles/PMC9917432/ /pubmed/36769391 http://dx.doi.org/10.3390/jcm12030745 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Marai, Ibrahim
Haddad, Rabea
Andria, Nizar
Kinany, Wadi
Hazanov, Yevgeni
Kleinberg, Bruce M.
Birati, Edo
Carasso, Shemy
Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title_full Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title_fullStr Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title_full_unstemmed Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title_short Left Ventricular “Longitudinal Rotation” and Conduction Abnormalities—A New Outlook on Dyssynchrony
title_sort left ventricular “longitudinal rotation” and conduction abnormalities—a new outlook on dyssynchrony
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9917432/
https://www.ncbi.nlm.nih.gov/pubmed/36769391
http://dx.doi.org/10.3390/jcm12030745
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