Assessment of cardiac function and synchronicity in subjects with isolated bundle branch block using Doppler imaging

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Author:
NIU Hong-xia()
HUA Wei()
ZHANG Shu()
SUN Xin()
WANG Fang-zheng()
CHEN Ke-ping()
WANG Hao()
CHEN Xin()
Journal Title:
CHINESE MEDICAL JOURNAL
Issue:
Volume 119, Issue 10, 2006
DOI:
Key Word:
bundle branch block;synchronicity;cardiac function;tissue Doppler imaging

Abstract: Background Using tissue Doppler imaging and conventional echocardiographic technique, we examined the cardiac function and synchronicity in individuals with isolated right bundle branch block (RBBB) or left bundle branch block (LBBB) and assessed the relationship between QRS duration and synchronicity.Methods Subjects with isolated RBBB (n=20), LBBB (n=10) and normal controls (n=20) were studied with conventional echocardiography and tissue Doppler imaging. The difference between aortic and pulmonary preejection intervals was defined as interventricular delay. Parameters in septum and lateral wall were measured using tissue Doppler imaging, including peak sustained systolic velocity (SM), peak early (EM) and late (AM)diastolic velocities as well as time to peak velocities (Ts, TE and TA).Results Subjects with LBBB had lower SM and longer Ts than did the RBBB and control groups (P<0.05,P<0.001 respectively). A significant difference was observed in EM, being the lowest in the LBBB and the highest in the control group (P<0.05). Moreover, TE was longer in the LBBB group compared with the other two groups (P<0.001). Both AM and TA were similar among three groups (P>0.05). In the bundle branch block groups, one ventricle lagged about 40 ms behind the other. A significant correlation was found between interventricular delay and QRS duration (r =0.713, P<0.001).Conclusions Cardiac ventricles were not well synchronized with one ventricle lagging about 40 ms behind the other in subjects with LBBB or RBBB, even though only LBBB group showed barely perceptible, impaired cardiac function. In addition, QRS duration and cardiac asynchronicity were positively correlated.

  • [1]Fahy G J,Pinski SL,Miller DP,McCabe N,Pye C,Walsh M J,et al.Natural history of isolated bundle branch block.Am J Cardiol1996; 77:1185-1160.
  • [2]Ozdemir K,Altunkeser BB,Danis G,Ozdemir A,Uluca Y,Tokac M,et al.Effect of the isolated left bundle branch block on systolic and diastolic functions of left ventricle.J Am Soc Echocardiogr 2001; 14:1075-1079.
  • [3]Zhou Q,Henein M,Coats A,Gibson D.Different effects of abnormal activation and myocardial disease on left ventricular ejection and filling times.Heart 2000; 84:272-276.
  • [4]Waggoner AD,Bierig SM.Tissue Doppler imaging:a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function.J Am Soc Echocardiog 2001; 14:1143-1152.
  • [5]Nelson GS,Curry CW,Wyman BT,Kramer A,Declerck J,Talbot M,et al.Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay.Circulation 2000; 101:2703-2709.
  • [6]Pitzalis MV,lacoviello M,Romito R,Massari F,Rizzon B,Luzzi G,et al.Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchronicity.J Am Coil Cardiol 2002; 40:1615-1622.
  • [7]Yu CM,Chau E,Sanderson JE,Fan K,Tang MO,Fung WH,et al.Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure.Circulation 2002; 105:438-445.
  • [8]Bax J J,Molhoek SG,van Erven L,Voogd P J,Somer S,Boersma E,et al.Usefulness of myocardial tissue Doppler echocardiography to evaluate left ventricular dyssynchronicity before and after biventricular pacing in patients with idiopathic dilated cardiomyopathy.Am J Cardiol 2003; 91:94-97.
  • [9]Mirvis DM,Goldberger AL.Electrocardiography.In:Braunwald E,Zipes DP,Libby P,eds.Heart disease:A textbook of cariovascular medicine.6th ed.Philadephia:WB Saunders Co.; 2001:83-128.
  • [10]Schiller NB,Shah PM,Crawford M,DeMaria A,Devereux R,Feigenbaum H,et al.Recommendations for quantitation of the left ventricle by two-dimensional echocardiography.American Society of Echocardiography Committee on Standards,Subcommittee on Quantitation of Two-Dimensional Echocardiograms.J Am Soc Echocardiogr 1989; 2:358-367.
  • [11]Rouleau F,Merheb M,Geffroy S,Berthelot J,Chaleil D,Dupuis JM,et al.Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy.Pacing Clin Electrophysiol 2001; 24:1500-1506.
  • [12]Lind B,Nowak J,Dorph J,van der Linden J,Brodin LA.Analysis of temporal requirements for myocardial tissue velocity imaging.Eur J Echocardiogr 2002; 3:214-219.
  • [13]Pai RG,Gill KS.Amplitude,durations,and timings of apically directed left ventricular myocardial velocities:Ⅰ.Their normal pattern and coupling to ventricular filling and ejection.J Am Soc Echocardiogr 1998; 11:105-111.
  • [14]Sanderson JE,Wang M,Yu CM.Tissue Doppler imaging for predicting outcome in patients with cardiovascular disease.Curr Opin Cardiol 2004; 19:458-463.
  • [15]Yip G,Wang M,Zhang Y,Fung JW,Ho PY,Sanderson JE.Left ventricular long axis function in diastolic heart failure is reduced in both systole and diastole:time for a redefinition.Heart 2002; 87:121-125.
  • [16]Alam M,Wardell J,Andersson E,Nordlander R,Samad B.Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation.J Am Soc Echocardiogr 2003; 16:240-245.
  • [17]Lee SJ,McCulloch C,Mangat I,Foster E,De Marco T,Saxon LA.Isolated bundle branch block and left ventricular dysfunction.J Card Fail 2003; 9:87-92.
  • [18]Wang M,Yip GW,Wang AY,Zhang Y,Ho PY,Tse MK,et al.Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value.J Am Coll Cardiol 2003; 41:820-826.
  • [19]D'Andrea A,Caso P,Sarubbi B,D'Alto M,Giovanna Russo M,Scherillo M,et al.Right ventricular myocardial activation delay in adult patients with right bundle branch block late after repair of Tetralogy of Fallot.Eur J Echocardiogra 2004; 5:123-131.
  • [20]Yu CM,Lin H,Ho PC,Yang H.Assessment of left and right ventricular systolic and diastolic synchronicity in normal subjects by tissue doppler echocardiography and the effects of age and heart rate.Echocardiography 2003;20:19-27.
  • [21]Kang S J,Song JK,Yang HS,Song JM,Kang DH,Rhee KS,et al.Systolic and diastolic regional myocardial motion of pacing induced versus idiopathic left bundle branch block with and without left ventricular dysfunction.Am J Cardiol 2004; 93:1243-1246.
  • [22]Quintana M,Saha S,Rohani M,del Furia F,Roumina M S,Lind B,et al.Electromechanical coupling,uncoupling,and ventricular function in patients with bundle branch block:a tissue-Doppler echocardiographic study.Echocardiography 2004; 21:687-698.
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