Skip to main content
SpringerLink
Log in

Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging

  • Original paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The diagnostic evaluation of patients with isolated left bundle branch block (LBBB) is challenging due to limitations of several non-invasive tests. Our aim was to evaluate the diagnostic value of cardiovascular magnetic resonance (CMR) in asymptomatic patients with LBBB. Sixty-one asymptomatic patients with complete LBBB who were referred for CMR from January 2005 to November 2010 were identified. 29 patients (18 men) had normal echocardiograms (echo) whereas 25 (18 men) had abnormal findings on echo. Six had no echo and one had poor echo windows, and these patients were excluded from further analysis. Patients with cardiac symptoms or known coronary artery disease at the time of referral were also excluded. Of the 29 patients with normal echo, 9 (31%) were found to have pathological findings on CMR. The most common abnormalities were dilated cardiomyopathy-DCM (n = 6, 21%) followed by left ventricular hypertrophy (n = 2, 7%). Of the 25 patients who had an abnormal echo, CMR confirmed the diagnosis in 19 (76%) and provided clinically relevant additional information in 13 (52%) subjects. Of these 13 patients, 9 (69%) had characteristic patterns of myocardial late gadolinium enhancement (8 mid-wall and 1 patchy distribution consistent with DCM and cardiac sarcoid, respectively). CMR detects sub-clinical cardiomyopathy in a third of asymptomatic patients with LBBB despite normal echocardiograms. In those with abnormal echocardiograms, CMR provides additional clinically relevant information in over 50% of patients, including a high prevalence of mid-wall fibrosis in patients with impaired left ventricular function. These findings support the use of CMR as a valuable adjunct to conventional investigations in asymptomatic LBBB.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Francia P, Balla C, Paneni F, Volpe M (2007) Left bundle-branch block–pathophysiology, prognosis, and clinical management. Clin Cardiol 30(3):110–115. doi:10.1002/clc.20034

    Article  PubMed  Google Scholar 

  2. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, Campana C, Perini G, Deorsola A, Masotti G, Tavazzi L, Maggioni AP (2002) Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J 143(3):398–405

    Article  PubMed  Google Scholar 

  3. Schneider JF, Thomas HE Jr, Kreger BE, McNamara PM, Kannel WB (1979) Newly acquired left bundle-branch block: the Framingham study. Ann Intern Med 90(3):303–310

    PubMed  CAS  Google Scholar 

  4. Schneider JF, Thomas HE Jr, McNamara PM, Kannel WB (1985) Clinical-electrocardiographic correlates of newly acquired left bundle branch block: the Framingham Study. Am J Cardiol 55(11):1332–1338

    Article  PubMed  CAS  Google Scholar 

  5. Fahy GJ, Pinski SL, Miller DP, McCabe N, Pye C, Walsh MJ, Robinson K (1996) Natural history of isolated bundle branch block. Am J Cardiol 77(14):1185–1190

    Article  PubMed  CAS  Google Scholar 

  6. Miller WL, Ballman KV, Hodge DO, Rodeheffer RJ, Hammill SC (2005) Risk factor implications of incidentally discovered uncomplicated bundle branch block. Mayo Clin Proc 80(12):1585–1590

    Article  PubMed  Google Scholar 

  7. Zannad F, Huvelle E, Dickstein K, van Veldhuisen DJ, Stellbrink C, Kober L, Cazeau S, Ritter P, Maggioni AP, Ferrari R, Lechat P (2007) Left bundle branch block as a risk factor for progression to heart failure. Eur J Heart Fail 9(1):7–14. doi:10.1016/j.ejheart.2006.04.011

    Article  PubMed  Google Scholar 

  8. Bouzas-Mosquera A, Peteiro J, Alvarez-Garcia N, Broullon FJ, Garcia-Bueno L, Ferro L, Perez R, Bouzas B, Fabregas R, Castro-Beiras A (2009) Prognostic value of exercise echocardiography in patients with left bundle branch block. JACC Cardiovasc Imaging 2(3):251–259. doi:10.1016/j.jcmg.2008.11.014

    Article  PubMed  Google Scholar 

  9. Geleijnse ML, Vigna C, Kasprzak JD, Rambaldi R, Salvatori MP, Elhendy A, Cornel JH, Fioretti PM, Roelandt JR (2000) Usefulness and limitations of dobutamine-atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study. Eur Heart J 21(20):1666–1673. doi:10.1053/euhj.1999.2008

    Article  PubMed  CAS  Google Scholar 

  10. Ghostine S, Caussin C, Daoud B, Habis M, Perrier E, Pesenti-Rossi D, Sigal-Cinqualbre A, Angel CY, Lancelin B, Capderou A, Paul JF (2006) Non-invasive detection of coronary artery disease in patients with left bundle branch block using 64-slice computed tomography. J Am Coll Cardiol 48(10):1929–1934. doi:10.1016/j.jacc.2006.04.103

    Article  PubMed  Google Scholar 

  11. Einstein AJ (2009) Medical imaging: the radiation issue. Nat Rev Cardiol 6(6):436–438. doi:10.1038/nrcardio.2009.53

    Article  PubMed  Google Scholar 

  12. Flett AS, Westwood MA, Davies LC, Mathur A, Moon JC (2009) The prognostic implications of cardiovascular magnetic resonance. Circ Cardiovasc Imaging 2(3):243–250

    Article  PubMed  Google Scholar 

  13. Karamitsos TD, Francis JM, Myerson S, Selvanayagam JB, Neubauer S (2009) The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol 54(15):1407–1424

    Article  PubMed  Google Scholar 

  14. Rudolph A, Abdel-Aty H, Bohl S, Boye P, Zagrosek A, Dietz R, Schulz-Menger J (2009) Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling. J Am Coll Cardiol 53(3):284–291. doi:10.1016/j.jacc.2008.08.064

    Article  PubMed  Google Scholar 

  15. Al-Mallah M, Kwong RY (2009) Clinical application of cardiac CMR. Rev Cardiovasc Med 10(3):134–141

    PubMed  Google Scholar 

  16. Karamitsos TD, Arnold JR, Pegg TJ, Cheng AS, van Gaal WJ, Francis JM, Banning AP, Neubauer S, Selvanayagam JB (2009) Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease. Int J Cardiovasc Imaging 25(3):277–283. doi:10.1007/s10554-008-9392-3

    Article  PubMed  Google Scholar 

  17. Karamitsos TD, Hudsmith LE, Selvanayagam JB, Neubauer S, Francis JM (2007) Operator induced variability in left ventricular measurements with cardiovascular magnetic resonance is improved after training. J Cardiovasc Magn Reson 9(5):777–783. doi:10.1080/10976640701545073

    Article  PubMed  Google Scholar 

  18. Bayes-Genis A, Lopez L, Vinolas X, Elosua R, Brossa V, Camprecios M, Mateo M, Cinca J, Bayes de Luna A (2003) Distinct left bundle branch block pattern in ischemic and non-ischemic dilated cardiomyopathy. Eur J Heart Fail 5(2):165–170

    Article  PubMed  Google Scholar 

  19. Imanishi R, Seto S, Ichimaru S, Nakashima E, Yano K, Akahoshi M (2006) Prognostic significance of incident complete left bundle branch block observed over a 40-year period. Am J Cardiol 98(5):644–648. doi:10.1016/j.amjcard.2006.03.044

    Article  PubMed  Google Scholar 

  20. Boyle DM, Fenton SS (1966) Left bundle branch block. Ulster Med J 35(1):93–99

    PubMed  CAS  Google Scholar 

  21. Dizadji H, Tahmooressi P, Cernock WF (1974) Etiology of left bundle branch block. Hemodynamic and angiographic studies. J Electrocardiol 7(3):221–226

    Article  PubMed  CAS  Google Scholar 

  22. Assomull RG, Prasad SK, Lyne J, Smith G, Burman ED, Khan M, Sheppard MN, Poole-Wilson PA, Pennell DJ (2006) Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol 48(10):1977–1985. doi:10.1016/j.jacc.2006.07.049

    Article  PubMed  Google Scholar 

  23. Grothues F, Smith GC, Moon JC, Bellenger NG, Collins P, Klein HU, Pennell DJ (2002) Comparison of interstudy reproducibility of cardiovascular magnetic resonance with two-dimensional echocardiography in normal subjects and in patients with heart failure or left ventricular hypertrophy. Am J Cardiol 90(1):29–34

    Article  PubMed  Google Scholar 

  24. van der Land V, Germans T, van Dijk J, Zwanenburg JJ, Spreeuwenberg M, Marcus JT, Kamp O, Gotte MJ, van Rossum AC (2007) The effect of left bundle branch block on left ventricular remodeling, dyssynchrony and deformation of the mitral valve apparatus: an observational cardiovascular magnetic resonance imaging study. Int J Cardiovasc Imaging 23(4):529–536. doi:10.1007/s10554-006-9187-3

    Article  PubMed  Google Scholar 

  25. Han Y, Chan J, Haber I, Peters DC, Zimetbaum PJ, Manning WJ, Yeon SB (2010) Circumferential myocardial strain in cardiomyopathy with and without left bundle branch block. J Cardiovasc Magn Reson 12:2. doi:10.1186/1532-429X-12-2

    Article  PubMed  Google Scholar 

  26. Rutz AK, Manka R, Kozerke S, Roas S, Boesiger P, Schwitter J (2009) Left ventricular dyssynchrony in patients with left bundle branch block and patients after myocardial infarction: integration of mechanics and viability by cardiac magnetic resonance. Eur Heart J 30(17):2117–2127. doi:10.1093/eurheartj/ehp212

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr Masliza Mahmod is funded by the National University of Malaysia and Ministry of Higher Education Malaysia. This work was supported by the British Heart Foundation (PG/08/101/26126) and by the Oxford NIHR Biomedical Research Centre. Stefan Neubauer also acknowledges support from the BHF Centre of Research Excellence, Oxford.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR), John Radcliffe Hospital, Oxford, OX3 9DU, UK

    Masliza Mahmod, Theodoros D. Karamitsos, Joseph J. Suttie, Saul G. Myerson, Stefan Neubauer & Jane M. Francis

Authors
  1. Masliza Mahmod
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Theodoros D. Karamitsos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph J. Suttie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Saul G. Myerson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Neubauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jane M. Francis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jane M. Francis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mahmod, M., Karamitsos, T.D., Suttie, J.J. et al. Prevalence of cardiomyopathy in asymptomatic patients with left bundle branch block referred for cardiovascular magnetic resonance imaging. Int J Cardiovasc Imaging 28, 1133–1140 (2012). https://doi.org/10.1007/s10554-011-9931-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-011-9931-1

Keywords

Search

Navigation