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1.
J Card Fail ; 26(7): 626-632, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32544622

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a respiratory syndrome with high rates of mortality, and there is a need for easily obtainable markers to provide prognostic information. We sought to determine whether the electrocardiogram (ECG) on hospital presentation provides prognostic information, specifically related to death. METHODS AND RESULTS: We performed a retrospective cohort study in patients with COVID-19 who had an ECG at or near hospital admission. Clinical characteristics and ECG variables were manually abstracted from the electronic health record and first ECG. Our primary outcome was death. THERE WERE: 756 patients who presented to a large New York City teaching hospital with COVID-19 who underwent an ECG. The mean age was 63.3 ± 16 years, 37% were women, 61% of patients were nonwhite, and 57% had hypertension; 90 (11.9%) died. In a multivariable logistic regression that included age, ECG, and clinical characteristics, the presence of one or more atrial premature contractions (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.23-5.36, P = .01), a right bundle branch block or intraventricular block (OR 2.61, 95% CI 1.32-5.18, P = .002), ischemic T-wave inversion (OR 3.49, 95% CI 1.56-7.80, P = .002), and nonspecific repolarization (OR 2.31, 95% CI 1.27-4.21, P = .006) increased the odds of death. ST elevation was rare (n = 5 [0.7%]). CONCLUSIONS: We found that patients with ECG findings of both left-sided heart disease (atrial premature contractions, intraventricular block, repolarization abnormalities) and right-sided disease (right bundle branch block) have higher odds of death. ST elevation at presentation was rare.


Assuntos
Betacoronavirus , Bloqueio de Ramo/mortalidade , Infecções por Coronavirus/mortalidade , Eletrocardiografia/mortalidade , Insuficiência Cardíaca/mortalidade , Pneumonia Viral/mortalidade , Idoso , Idoso de 80 Anos ou mais , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Estudos de Coortes , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Eletrocardiografia/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Estudos Retrospectivos
2.
Open Heart ; 7(1): e001199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32153792

RESUMO

Objectives: The physiological determinants of left ventricular (LV) mechanical dispersion (MD) are not fully explored. We aimed to investigate the impact of afterload reduction and changes in ventricular conduction on LV MD after transcatheter aortic valve implantation (TAVI). Methods: Patients with severe aortic stenosis (AS) were examined in a prospective, repeated measures observational cohort study before and after an uncomplicated transfemoral TAVI in a single tertiary centre. LV MD was assessed by speckle tracking echocardiography. Valvulo-arterial impedance (ZVA) was used as a measure of global afterload. Results: We included 140 consecutive patients (83±8 years old, 49% women, logistic EuroSCORE 16±10) with severe AS (valve area 0.7±0.2 cm2, mean transvalvular gradient 54±18 mm Hg) and a relatively preserved LV ejection fraction (52%±11%). After TAVI, we observed favourable changes in transvalvular gradients and ZVA in all patients. Compared with baseline, postprocedural MD was significantly lower in 108 patients with unchanged ventricular conduction (55±17 ms vs 51±17 ms, p=0.02) and higher in 28 patients with TAVI-induced left bundle branch block (51±13 ms vs 62±19 ms, p≤0.001). During 22±9 months observation, 22 patients died. Postprocedural MD was associated with mortality in a univariate Cox regression model (HR=1.24 (1.01-1.52), p<0.04, per 10 ms increase). Conclusions: Isolated afterload reduction was associated with reduction of MD, while concomitant impairment of ventricular conduction resulted in a more pronounced MD after TAVI, indicating that loading conditions and conduction should be considered when evaluating MD. A pronounced postprocedural LV MD was associated with mortality.


Assuntos
Potenciais de Ação , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bloqueio de Ramo/etiologia , Frequência Cardíaca , Substituição da Valva Aórtica Transcateter/efeitos adversos , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/mortalidade , Bloqueio de Ramo/fisiopatologia , Ecocardiografia , Eletrocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia
3.
Circ Arrhythm Electrophysiol ; 13(4): e008239, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32186936

RESUMO

Left bundle branch block may be due to conduction system degeneration or a reflection of myocardial pathology. Left bundle branch block may also develop following aortic valve disease or cardiac procedures. Patients with heart failure with reduced ejection fraction and left bundle branch block may respond positively to cardiac resynchronization therapy. Lead placement via the coronary sinus is the mainstay approach of cardiac resynchronization therapy. However, other options, including physiological pacing, are being explored. In this review, we summarize the salient pathophysiologic and clinical aspects of left bundle branch block, as well as current and future strategies for management.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Frequência Cardíaca , Potenciais de Ação , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/mortalidade , Bloqueio de Ramo/fisiopatologia , Terapia de Ressincronização Cardíaca/efeitos adversos , Terapia de Ressincronização Cardíaca/mortalidade , Humanos , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento
4.
Int J Cardiovasc Imaging ; 36(6): 1041-1050, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32056088

RESUMO

New-onset left bundle branch block (LBBB) is a frequent complication after transcatheter aortic valve replacement (TAVR) and provides an opportunity to study dyssynchrony immediately following acute LBBB. This study aims to (1) assess echocardiographic dyssynchrony in acute TAVR-induced LBBB (TAVR-LBBB), and (2) compare dyssynchrony parameters among different patient groups with LBBB. The study enrolled all TAVR-LBBB patients at Ghent University Hospital between 2013 and 2019. First, acute TAVR-LBBB dyssynchrony was assessed by: (1) septal flash (SF); (2) interventricular mechanical delay (IVMD; cut-off ≥ 40 ms) and (3) presence of 'classical dyssynchronous strain pattern' assessed with speckle tracking. Secondly, acute TAVR-LBBB patients with SF (LBBBTAVR+SF) were compared to randomly selected LBBB-SF patients with preserved (LBBBSF+PEF) ànd reduced ejection fraction (LBBBSF+REF). In TAVR-LBBB patients (n = 25), SF was detected in 72% of patients, whereas only 5% of TAVR-LBBB patients showed a classical dyssynchronous strain pattern. IVMD in these TAVR-LBBB patients was 39 ms. In 90% of LBBBTAVR+SF patients, SF was observed within 24 h after LBBB onset. Among LBBB-SF patients, a classical strain pattern was more prevalent in LBBBSF+REF patients compared to LBBBTAVR+SF patients (80% vs. 7%; p < 0.001). IVMD was significantly longer in LBBBSF+PEF patients (52 ms; p = 0.002) and LBBBSF+REF patients (57 ms; p = 0.009) compared to LBBBTAVR+SF patients (37 ms). SF is an early and prevalent marker of LV dyssynchrony in acute TAVR-LBBB, whereas strain-based measures and IVMD do not appear to capture dyssynchrony at this early stage. Our findings from the comparative analysis generate the hypothesis that progressive LBBB-induced LV remodeling may be required for a 'classical dyssynchrony strain pattern' or significant IVMD to occur in TAVR-LBBB patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/diagnóstico , Ecocardiografia , Eletrocardiografia , Septos Cardíacos/diagnóstico por imagem , Volume Sistólico , Substituição da Valva Aórtica Transcateter/efeitos adversos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Bélgica/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/fisiopatologia , Feminino , Septos Cardíacos/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/epidemiologia , Disfunção Ventricular Esquerda/fisiopatologia , Remodelação Ventricular
5.
Zhonghua Er Ke Za Zhi ; 58(2): 107-112, 2020 Feb 02.
Artigo em Chinês | MEDLINE | ID: mdl-32102146

RESUMO

Objective: To explore the safety and effectiveness of left bundle branch area pacing (LBBAP) in children. Methods: Clinical data, pacing electrocardiogram and parameters of 6 patients (5 females and 1 male) who underwent permanent pacemaker implantation and LBBAP from January to June 2019 in the Department of Pediatric Cardiology of Anzhen Hospital were retrospectively analyzed. Results: The weight of the 6 patients aged between 9 and 14 years ranged from 26 to 48 kg. Five patients were diagnosed with third degree atrioventricular block, and 1 patient was diagnosed with cardiac dysfunction after right ventricular apical pacing. Cardiac function decreased in one patient and remained normal in the other five patients. Left ventricular end diastolic diameter (LVEDD) Z score was 1.85±0.65. V(1) lead showed changes like right bundle branch block in pacing electrocardiogram. No significant difference was found regarding QRS wave duration ((95±13) ms vs. (111±20) ms, t=-1.610, P>0.05) between preoperation and postoperation. Pacing threshold was (0.85±0.26) V. The sensing threshold was (15.0±4.3) mV and the impedance was (717±72) Ω. P potential was recorded in 3 cases. The earliest left ventricular local activation time was (56±5) ms and remained stable at different output voltages. Postoperative echocardiography revealed that the electrodes were located near the endocardium of the left ventricular septum. No complications such as myocardial perforation and electrode dislocation occurred during follow-up. The pacing threshold, sensing threshold and impedance were (0.60±0.09)V, (16.1±3.9)mV, (662±78)Ω respectively at 3 months after operation. The patient with low left ventricular ejection fraction (LVEF) recovered to normal on the 3 rd day after LBBAP (45% vs. 57%). The LVEDD Z score decreased to (1.1±0.3) at 3 months after operation and was significantly lower than that before operation (t=2.38, P<0.05). Conclusions: LBBAP in children can achieve narrow QRS pacing andphysiological pacing with stablepacing parameters. It can improve left ventricular enlargement caused by long-term bradycardia, and cardiac dysfunction and cardiac enlargement caused by long-term right ventricular apical pacing quickly and effectively.LBBAP is safe and feasible for older children in the near future. However, the long term potential risks of LBBAP need further observation and study.


Assuntos
Bloqueio Atrioventricular/cirurgia , Bloqueio de Ramo/fisiopatologia , Estimulação Cardíaca Artificial , Marca-Passo Artificial , Função Ventricular Esquerda/fisiologia , Adulto , Bloqueio de Ramo/diagnóstico por imagem , Criança , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Septo Interventricular
6.
BMC Cardiovasc Disord ; 20(1): 89, 2020 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093607

RESUMO

BACKGROUND: Acute coronary syndrome (ACS) with high-grade atrioventricular block (HAVB) still has a poor mortality risk, even in the current percutaneous coronary intervention (PCI) era. However, early PCI for ACS with HAVB is associated with improved in-hospital survival and a 6-month survival similar to that of ACS without HAVB. CASE PRESENTATION: A 70-year-old man was admitted to our hospital for ACS with HAVB. ECG showed complete AV block, complete right bundle branch block (CRBBB), and left axis deviation. Cardiac enzymes were elevated. He underwent temporary pacemaker insertion and coronary angiography, which showed severe stenosis of the proximal right coronary artery (RCA), 99% stenosis of the distal RCA with Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow, and total occlusion of the proximal left anterior descending artery (LAD). We performed primary PCI in both the RCA and LAD, which resulted in TIMI grade 3 flow in both. After PCI, the HAVB recovered to normal sinus rhythm with CRBBB; a normal QRS interval returned within three days. The patient was discharged from the hospital without complications. CONCLUSION: In this case of ACS with HAVB, early intensive coronary artery reperfusion resulted in long-term patient survival. The blood supply to the AV node and bilateral bundle branches is complex. Multivessel ischemia may compromise both primary and collateral blood flows to the AV node and septum, resulting in severe conduction impairment. Clinicians performing PCI should be aware of this anatomy and physiology.


Assuntos
Síndrome Coronariana Aguda/terapia , Bloqueio Atrioventricular/diagnóstico , Bloqueio de Ramo/diagnóstico , Eletrocardiografia , Frequência Cardíaca , Intervenção Coronária Percutânea , Potenciais de Ação , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Bloqueio Atrioventricular/complicações , Bloqueio Atrioventricular/fisiopatologia , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Circulação Colateral , Angiografia Coronária , Circulação Coronária , Stents Farmacológicos , Humanos , Masculino , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento
7.
Eur Radiol ; 30(4): 2010-2020, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31953665

RESUMO

OBJECTIVES: To investigate the diagnostic value and reproducibility of deformable registration algorithm (DRA)-derived mechanical dyssynchrony parameters in dilated cardiomyopathy (DCM) patients. METHODS: The present study included 80 DCM patients (40 with normal QRS duration (NQRS-DCM); 40 with left bundle branch block (LBBB-DCM)) and 20 healthy volunteers. The balanced steady-state free-precession (bSSFP) cine images were acquired using a 3.0T scanner. Mechanical dyssynchrony parameters were calculated based on DRA-derived segmental strain, including uniformity ratio estimate (URE) and standard derivation of time-to-peak (T2Psd) parameters in circumferential, radial, and longitudinal orientations. RESULTS: DCM patients showed significant mechanical dyssynchrony reflected by both URE and T2Psd parameters compared with controls. Among DCM patients, LBBB-DCM showed decreased CURE (0.78 ± 0.21 vs. 0.93 ± 0.05, p < 0.001) and RURE (0.69 ± 0.14 vs. 0.83 ± 0.15, p = 0.001), and increased T2Psd-Ecc (median with interquartile range, 94.1 (54.4-123.2) ms vs. 63.7 (44.9-80.4) ms, p = 0.003) and T2Psd-Err (91.1 (61.1-103.2) ms vs. 62.3 (46.3-104.5) ms, p = 0.041) compared with NQRS-DCM patients. CURE showed a strong correlation with QRS duration (r = - 0.54, p < 0.001), with maximum AUC (0.791) to differentiate LBBB-DCM from NQRS-DCM patients. Improved intra- and inter-observer reproducibility was found using URE indices (coefficient of variation (CoV), 1.20-3.17%) than T2Psd parameters (CoV, 15.28-41.18%). CONCLUSIONS: The DRA-based CURE showed significant correlation with QRS duration and the highest discriminatory value between LBBB-DCM and NQRS-DCM patients. URE indices showed greater reproducibility compared with T2Psd parameters for assessing myocardial dyssynchrony in DCM patients. KEY POINTS: • The strain analyses based on DRA suggested that DCM patients have varying degrees of mechanical dyssynchrony and there is a significant difference from normal controls. • CURE showed the strongest correlation with QRS duration and was the best parameter for differentiating DCM patients with normal QRS duration from patients with LBBB, and with normal controls. • URE indices showed improved reproducibility compared with T2Psd parameters in all three orientations (circumferential, radial, and longitudinal).


Assuntos
Cardiomiopatia Dilatada/diagnóstico por imagem , Cardiomiopatia Dilatada/fisiopatologia , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Algoritmos , Bloqueio de Ramo/complicações , Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Cardiomiopatia Dilatada/complicações , Feminino , Coração/efeitos dos fármacos , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/fisiopatologia
8.
Am J Cardiol ; 125(5): 795-802, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31889524

RESUMO

This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.


Assuntos
Valva Aórtica/cirurgia , Bloqueio de Ramo/fisiopatologia , Estimulação Cardíaca Artificial , Eletrocardiografia , Complicações Pós-Operatórias/fisiopatologia , Recuperação de Função Fisiológica , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Comorbidade , Feminino , Humanos , Incidência , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/terapia
9.
Am J Cardiol ; 125(1): 107-113, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732136

RESUMO

The objective of this study was to determine the long-term (>1 year) electrocardiographic (ECG) and clinical outcomes of patients without significant changes in their electrocardiogram after transcatheter aortic valve implantation (TAVI; including patients with pre-existing ECG abnormalities). Among 772 consecutive patients who underwent TAVI in our institution, 397 patients (51%) without new ECG changes were included. TAVI patients were divided into 2 groups according to the presence of pre-existing ECG-conduction disturbances (ECG-CD: 140 patients, non-ECG-CD: 257 patients). Clinical follow-up (median: 35 [22 to 57] months) was complete in all patients but 5 (1.2%), and ECG data were available in 291 patients (84.3% of patients at risk) at a median of 29 (20 to 50) months. In the non-ECG-CD group, most patients (79.8%) remained without significant ECG changes at follow-up, and 16.9% developed first-degree atrioventricular block and/or bundle branch block over time. The rate of permanent pacemaker (PPM) implantation at follow-up was 3.5% (1.1%/year) in the non-ECG-CD group versus 15.7% (5.5%/year) in the ECG-CD group (p <0.001). The presence of pre-existing CD was an independent predictor of PPM at follow-up (hazard ratio [HR] 4.67, 95% confidence interval [CI] 2.15 to 10.16, p <0.001). The ECG-CD group exhibited a higher risk of heart failure hospitalization (non-ECG-CD: 25%, ECG-CD: 29%, log-rank p = 0.01), but not mortality (non-ECG-CD: 50%, ECG-CD: 46%, log-rank p = 0.60) at 5-year follow-up. In conclusion, the ECG remained unchanged in most TAVI recipients without new postprocedural CD. Pre-existing ECG-CD was associated with an increased risk of PPM and heart failure hospitalization at long-term follow-up. These results provide reassuring data in the era of TAVI expanding toward candidates with a longer life expectancy, and highlight the importance of a closer follow-up of those patients with pre-existing ECG-CDs.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio Atrioventricular/complicações , Bloqueio de Ramo/complicações , Estimulação Cardíaca Artificial/métodos , Eletrocardiografia/métodos , Sistema de Condução Cardíaco/fisiopatologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Bloqueio Atrioventricular/fisiopatologia , Bloqueio Atrioventricular/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
Clin Nucl Med ; 45(1): 7-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789912

RESUMO

BACKGROUND: Patients with left bundle-branch block (LBBB) can be classified to discordant LBBB (dLBBB) and concordant LBBB (cLBBB) according to T-wave orientation in lateral leads. This classification indicates different functional left ventricular (LV) parameters with worse prognosis in dLBBB patients. However, there are no data regarding the impact of this classification on perfusion status of the left ventricle. The aim of this study is to evaluate and compare the SPECT myocardial perfusion imaging (MPI) findings of LV perfusion and function between dLBBB and cLBBB patients. METHODS: All patients who were referred for SPECT MPI during an 11 months' period were evaluated. Patients with evidence of LBBB on standard baseline 12-lead ECG were included, and their demographic, medical history, and imaging data were recorded. Quantitative perfusion and function parameters of LV included summed stress score, summed rest score, summed difference score, total perfusion deficit (TPD) at both phases with delta TPD, ejection fraction, end-diastolic volume, end-systolic volume, summed motion score, summed thickening score, phase SD, and phase histogram bandwidth. All baseline ECGs were further assessed by a cardiologist to categorize patients as the cLBBB or dLBBB group according to concordance of the T wave with QRS complex in lateral leads. RESULTS: Finally, 97 patients with 46 cLBBB and 51 dLBBB cases were included. Baseline characteristics and cardiovascular risk factors including diabetes mellitus, hypertension, hyperlipidemia, history of coronary artery disease (CAD), family history of CAD, and smoking were not significantly different between the 2 groups. However, summed stress score (12.2 vs 6.7), summed difference score (4.0 vs 2.6), stress TPD (11.0 vs 6.4), and delta TPD (4.8 vs 3.9) were significantly higher in dLBBB patients. In addition, functional parameters were also significantly worse in dLBBB patients with lower ejection fraction and higher end-diastolic volume, end-systolic volume, summed motion score, and summed thickening score in these patients. Mean phase SD and phase histogram bandwidth were also significantly higher in dLBBB patients. CONCLUSIONS: This study revealed that LBBB patients with discordant T wave in lateral leads have significantly higher ischemic scores and worse functional parameters with more dyssynchrony in gated SPECT MPI.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Bloqueio de Ramo/fisiopatologia , Tomografia Computadorizada por Emissão de Fóton Único de Sincronização Cardíaca , Circulação Coronária , Imagem de Perfusão do Miocárdio , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade
11.
Indian Heart J ; 71(4): 360-363, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31779867

RESUMO

There is a paucity of experience regarding His bundle pacing (HBP) at laboratories initially attempting the procedure, especially in the Indian scenario. Patient who underwent HBP were selected for pacing therapy or in lieu of cardiac resynchronization therapy (CRT) at a single center. Among 22 patients attempted, 19 patients underwent successful implant, achieving selective HBP in 14 patients. There was a significant improvement in left ventricular ejection fraction (LVEF) (49.3 ± 9.3 vs. 36.7 ± 9.2) in the LV dysfunction subgroup (n = 6). Over a follow-up of 15 ± 6.5 months, thresholds were stable in all except one patient, and there was no requirement of lead revision. In summary, we found that HBP is a feasible option for achieving physiological pacing.


Assuntos
Fascículo Atrioventricular/fisiopatologia , Estimulação Cardíaca Artificial , Idoso , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/terapia , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Doença das Coronárias/fisiopatologia , Doença das Coronárias/terapia , Eletrocardiografia , Estudos de Viabilidade , Feminino , Humanos , Índia , Masculino
12.
Cardiovasc Ultrasound ; 17(1): 19, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601248

RESUMO

BACKGROUND: Nearly one-third of heart failure (HF) patients do not respond to cardiac resynchronization therapy (CRT) despite having left bundle branch block (LBBB). The aim of the study was to investigate a novel method of quantifying left ventricular (LV) contractile asymmetry in HF. METHODS: Patients with HF and LBBB undergoing CRT (n = 89, 37.1% females, 68 ± 9 years, ischemic etiology in 61%, LV ejection fraction 27.1 ± 7.1%) were analyzed. LV longitudinal systolic strain rate values were extracted from curved anatomical M-mode plots of standard long-axis 2D-echocardiography images and cubic spline interpolation was used to generate a 3D-phantom. Index of contractile asymmetry (ICA) was calculated based on standard deviation of differences in strain rate of opposing walls. Average ICA was individually assessed pairwise in 12 opposing 30-degree LV sectors. Reduction in LV end-systolic volume (ESV) ≥15% after 6 months was considered as positive response to CRT. RESULTS: CRT response was found in 66 (74.2%) patients. Responders with both ischemic and non-ischemic cardiomyopathy had a higher and more extensive contractile asymmetry at baseline and achieved a greater ICA reduction after CRT than non-responders. Higher baseline ICA predicted higher degree and wider extent of ICA improvement. Also, both ICA at baseline and reduction of ICA correlated with the degree of ESV reduction after CRT. CONCLUSIONS: Quantification of asymmetrical LV activation in 3D by ICA provides valuable insights into LV contraction in case of LBBB and is a promising tool for improved patient selection for CRT.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/métodos , Ecocardiografia Tridimensional/métodos , Insuficiência Cardíaca/terapia , Contração Miocárdica/fisiologia , Seleção de Pacientes , Volume Sistólico/fisiologia , Idoso , Bloqueio de Ramo/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Função Ventricular Esquerda/fisiologia
13.
Am J Cardiol ; 124(11): 1770-1774, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31586533

RESUMO

Patients with type 1 myotonic dystrophy show reduced left ventricular systolic function in the presence of left bundle branch block due to electromechanical dys-synchrony. Our prospective study tracked a cohort of 64 type 1 myotonic dystrophy patients that demonstrated a high burden of atrial and ventricular arrhythmias and conduction delays. Of these patients, 12 (19%) patients had left bundle branch block, which was associated with reduced left ventricular systolic function. Eight of these patients received cardiac resynchronization therapy devices resulting in reduction of median QRS complex duration from 173 to 166 ms (p = 0.04), and improvement in median left ventricular ejection fraction from 37% to 46% (p = 0.007). In conclusion, cardiac resynchronization therapy device therapy is both feasible and effective in treating advanced cardiac disease in this vulnerable group of patients by improving left ventricular function.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca/tendências , Eletrocardiografia , Distrofia Miotônica/complicações , Disfunção Ventricular Esquerda/terapia , Função Ventricular Esquerda/fisiologia , Adulto , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Volume Sistólico/fisiologia , Sístole , Resultado do Tratamento , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia
14.
Can J Cardiol ; 35(10): 1386-1393, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31492494

RESUMO

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has revolutionized the management of severe aortic stenosis. The development of a new-onset complete left bundle branch block (LBBB) is, however, a frequent complication. The objective of the present study was to assess the impact of a new-onset LBBB after TAVI on the evolution of left ventricular ejection fraction (LVEF). METHODS: Forty consecutive patients were included after the development of a new-onset LBBB after TAVI and were matched for age and LVEF with 40 patients implanted during the same period who did not develop an LBBB. The primary endpoint was evolution of the LVEF measured by echocardiography before implantation and between 6 and 12 months after TAVI. RESULTS: The development of an LBBB was associated with a 5-point decrease in LVEF [-12.5; 2.5], contrary to the non-LBBB group (1.5 [-6.5; 9.5], P = 0.007) at 8 months, with the persistence of the LBBB (n = 23) exacerbating this decrease (-7 [-13; 2], P = 0.009). When left ventricular dysfunction (LVEF < 50%) was present before TAVI, the appearance of an LBBB was associated with a reduction in LVEF (-2 [-8; 2]) contrary to the non-LBBB group (20 [9; 22], P = 0.02). CONCLUSIONS: The appearance of a new-onset LBBB after TAVI has a pejorative impact on left ventricular systolic function, particularly in patients with an initial LVEF < 50%, due to a lack of recovery of the latter, thereby potentially affecting their prognosis.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bloqueio de Ramo/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Sístole , Substituição da Valva Aórtica Transcateter , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos
15.
Indian Heart J ; 71(3): 229-234, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543195

RESUMO

BACKGROUND/AIM: Despite the well-established benefits of cardiac resynchronization therapy (CRT) in heart failure (HF) patients with left ventricular ejection fraction (LVEF) ≤35%, many patients with less reduced EF remain refractory to optimized medical treatment and at high risk of morbidity and mortality. The objective of the study is to evaluate the effects of CRT in optimally treated patients with New York Heart Association (NYHA) classes II-IV, LVEF of 36-45%, and left bundle branch (LBBB), including clinical, structural and biochemical response. METHODS: A selected group of HF patients have been implanted with CRT-P devices and were followed up for 6 months at 4, 12 and 24 weeks. Clinical assessment included NYHA class, quality of life and 6-min walk distance (6 MWD) test. Echocardiographic assessment included LV dimensions and function and left atrial volume. Serum N-terminal pro b-type natriuretic peptide (NT-ProBNP) was measured at the same intervals. RESULTS: This prospective single center study included 23 patients. NYHA functional class significantly improved after CRT-P (p < 0.0001), associated with improvement in QOL (p < 0.0001) and 6 MWD, which increased, from 145.7 ± 20.1 m to 219.5 ± 42.2 m (p < 0.0001). Mean QRS duration showed significant shortening from 164.4 ± 13.2 ms to 126.4 ± 13.6 ms (p < 0.0001). CRT induced reverse remodeling with reduction in both left ventricular end diastolic diameter (LVEDD) from 68.95 ± 5.05 mm to 62.8 ± 4.47 mm, p = 0.0002 and left ventricular end systolic diameter (LVESD) from 54.1 ± 4.5 mm to 46.5 ± 4.1 mm, p < 0.0001, and significant increase in LVEF (from 40.3 ± 2.8 to 48.3 ± 4.2 mm, p < 0.0001). The biochemical response to CRT showed significant reduction in serum NT-ProBNP from 1025.6 ± 363.1 pg/ml to 594.9 ± 263.5 pg/ml (p < 0.0001). CONCLUSIONS: Symptomatic HF patients on maximal optimized medical treatment who have LBBB and baseline LVEF 35-45% appeared to derive significant clinical and structural benefit from CRT.


Assuntos
Bloqueio de Ramo/terapia , Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca/terapia , Idoso , Bloqueio de Ramo/complicações , Bloqueio de Ramo/fisiopatologia , Dispositivos de Terapia de Ressincronização Cardíaca , Feminino , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia
16.
Indian Heart J ; 71(3): 256-262, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543199

RESUMO

OBJECTIVES: The aim of the study is to compare two advanced methods of evaluation of left ventricular mechanical dyssynchrony (LVMD), the speckle tracking echocardiography (STE) and the three-dimensional echocardiography (3DE). METHODS: One hundred thirty-six subjects, with or without LV dysfunction and with or without bundle branch block (BBB), were included in this study, designed to investigate agreement between magnitude and spatial pattern of LVMD as assessed by 3DE and STE. The frequency and severity of LVMD and localization of most asynchronous segments were compared. RESULTS: Both 3DE and STE revealed progressive rise in frequency and magnitude of LVMD with increasing disease severity. Dyssynchrony was dependent on left ventricle ejection fraction rather than the QRS duration. The frequency and magnitude of dyssynchrony were maximum in patients having LV dysfunction with left BBB. Compared with STE, 3DE diagnosed LVMD more frequently in patients having LV dysfunction with narrow QRS (17.6% vs 60.3%, respectively; P < 0.001). When the two methods were compared for localization of most asynchronous segments, the results matched only in about 50% cases. CONCLUSIONS: Both 3DE and STE provided consistent results with progressive rise in magnitude of LVMD, correlating with disease severity. 3DE diagnosed more patients as having LVMD in those having LV dysfunction with narrow QRS. The most delayed segment assessed by two methods matched only in about half the cases. Correlation with clinical CRT responsiveness is needed to conclude which method is more accurate in dyssynchrony mapping for targeted lead placement.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Ecocardiografia Tridimensional , Ecocardiografia/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Bloqueio de Ramo/fisiopatologia , Estudos Transversais , Feminino , Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434668

RESUMO

We present the case of a 65-year-old woman who was referred urgently from primary care with worsening breathlessness for 3 weeks, associated with tachycardia and left bundle branch block (LBBB). She had a background of type 2 diabetes, asthma and hypertension. Initial ECG revealed atrial fibrillation with the fast ventricular rate on the background of LBBB. ECHO findings were consistent with systolic impairment. Initial testing including checking thyroid function test revealed hyperthyroidism. It became evident that this patient had thyrotoxic cardiomyopathy. Early advice from the endocrine team was sought and the patient was treated with a combination of carbimazole and ivabradine. After a hospital stay, she made a remarkable recovery.


Assuntos
Bloqueio de Ramo/diagnóstico , Cardiomiopatias/diagnóstico , Anti-Hipertensivos/uso terapêutico , Bisoprolol/uso terapêutico , Bloqueio de Ramo/tratamento farmacológico , Bloqueio de Ramo/fisiopatologia , Carbimazol/uso terapêutico , Cardiomiopatias/tratamento farmacológico , Cardiomiopatias/fisiopatologia , Diabetes Mellitus Tipo 2 , Dispneia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Taquicardia , Resultado do Tratamento
19.
J Am Coll Cardiol ; 74(5): 645-655, 2019 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-31370956

RESUMO

BACKGROUND: Conduction abnormalities including bundle branch block are recognized sequelae following septal myectomy in patients with hypertrophic cardiomyopathy, but their incidence and effect on long-term mortality have not been well studied. OBJECTIVES: This study was conducted to determine the impact of conduction abnormalities on mortality in patients with obstructive hypertrophic cardiomyopathy following myectomy. METHODS: The outcomes of 2,482 patients with obstructive hypertrophic cardiomyopathy who underwent transaortic septal myectomy from 1961 to 2016 were analyzed. Pre-operative and early post-operative electrocardiograms were reviewed to determine conduction status. The study endpoint was all-cause mortality. RESULTS: Mean age at operation was 54.2 ± 14.6 years, and 1,370 patients (55.2%) were men. Pre-operatively, 2,159 patients (87.0%) had normal conduction, of whom 38.8% developed left bundle branch block, 1.1% developed right bundle branch block (RBBB), and 0.6% had complete heart block (CHB) after myectomy. Among 112 patients with baseline RBBB, 34.8% developed CHB post-operatively. Overall, only 2.3% of patients developed CHB. Over a median follow-up period of 8.6 years, overall mortality differed among post-operative conduction groups after adjustment for age, sex, and concomitant procedures (p = 0.015). Specifically, mortality in those with paced rhythm after myectomy was significantly increased relative to those with normal conduction (hazard ratio: 1.57; 95% confidence interval: 1.15 to 2.14; p = 0.005), although no significant difference was observed in left bundle branch block and RBBB (vs. normal) groups. CONCLUSIONS: Left bundle branch block is a common sequela after septal myectomy but does not influence post-operative mortality. Myectomy-related CHB is rare in patients with baseline normal conduction, while pre-existing RBBB greatly increases the risk for CHB. Persistent paced rhythm after operation is an independent predictor of mortality.


Assuntos
Bloqueio de Ramo/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cardiomiopatia Hipertrófica/cirurgia , Eletrocardiografia , Sistema de Condução Cardíaco/fisiopatologia , Septos Cardíacos/cirurgia , Complicações Pós-Operatórias , Bloqueio de Ramo/etiologia , Bloqueio de Ramo/fisiopatologia , Cardiomiopatia Hipertrófica/mortalidade , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Taxa de Sobrevida/tendências
20.
Am J Emerg Med ; 37(10): 1991.e5-1991.e7, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31395406

RESUMO

Acute myocardial infarction (AMI) diagnosis in patients with pre-existing left bundle branch block (LBBB) can be difficult. Undiagnosed or delayed diagnosis of AMI in these patients can put them at risk of having shock, mechanical complications, and death. We present a case of 77-year-old Caucasian male with a known LBBB and coronary artery bypass surgery for coronary artery disease who presented to the emergency department with a chief complaint of chest pain and shortness of breath. The patient had recurrent chest pain despite using aspirin, nitroglycerine, and morphine. An electrocardiogram (ECG) showed a new notch in the upslope of the R wave in leads I, AVL that indicated a positive Chapman's sign. Troponin levels were initially normal, but serial troponin showed elevated enzyme giving evidence of acute coronary syndrome (ACS). The patient was started on heparin drip and underwent subsequent coronary catheterization. Physicians should be aware of Chapman's sign on ECG in patients presenting with chest pain who have baseline LBBB as it might represent myocardial ischemia and warrant emergent treatment for ACS.


Assuntos
Bloqueio de Ramo/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Infarto do Miocárdio/diagnóstico por imagem , Idoso , Bloqueio de Ramo/fisiopatologia , Bloqueio de Ramo/terapia , Dor no Peito/diagnóstico por imagem , Dispneia , Eletrocardiografia , Humanos , Masculino , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/terapia , Resultado do Tratamento
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