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Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block and healthy controls

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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Abnormal electrical activation may cause dyssynchronous left ventricular (LV) contraction. In this study, we characterized and analyzed electrical and mechanical dyssynchrony in patient with left bundle branch block (LBBB) and healthy controls.

Methods

Myocardial perfusion imaging (MPI) data from 994 patients were analyzed. Forty-three patient fulfilled criteria for LBBB and 24 for controls. Electrical activation was characterized with vector electrocardiography (VECG) and LV function including mechanical dyssynchrony with ECG-gated MPI phase analysis.

Results

QRS duration (QRSd; r = 0.69, P < .001) and a few other VECG parameters correlated significantly with phase bandwidth (phaseBW) representing mechanical dyssynchrony. End-diastolic volume (EDV; r = 0.59, P < .001), ejection fraction and end-systolic volume correlated also with phaseBW. QRSd (β = 0.47, P < .001) and EDV (β = 0.36, P = .001) were independently associated with phaseBW explaining 55% of its variation. Sixty percent of patients with LBBB had significant mechanical dyssynchrony. Those patients had wider QRSd (159 vs 147 ms, P = .013) and larger EDV (144 vs 94 mL, P = .008) than those with synchronous LV contraction. Cut-off values for mechanical dyssynchrony seen in patients with LBBB were QRSd ≥ 165 ms and EDV ≥ 109 mL.

Conclusions

Despite obvious conduction abnormality, LBBB is not always accompanied by mechanical dyssynchrony. QRSd and EDV explained 55% of variation seen in phaseBW. These two parameters were statistically different between LBBB cases with and without mechanical dyssynchrony.

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Abbreviations

LBBB:

Left bundle branch block

MPI:

Myocardial perfusion imaging

VECG:

Vector electrocardiography

SPECT:

Single photon emission computerized tomography

QRSd:

QRS duration

EDV:

End-diastolic volume

phaseBW:

Phase bandwidth (phase analysis parameter describing mechanical dyssynchrony)

LBBBnor :

Left bundle branch block patient with normal (synchronous) left ventricular contraction

LBBBabn :

Left bundle branch block patient with abnormal (dyssynchronous) left ventricular contraction

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Disclosure

The research was financially supported by Finnish Foundation for Cardiovascular Research. The author Saara Sillanmäki has had educational support from GE Healthcare. Other researchers have nothing to declare.

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Authors and Affiliations

  1. Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Saara Sillanmäki MD, Mika P. Tarvainen PhD, Tiina Laitinen PhD, Hanna Hämäläinen MD & Tomi Laitinen MD, PhD

  2. Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland

    Saara Sillanmäki MD & Tomi Laitinen MD, PhD

  3. Department of Applied Physics, University of Eastern Finland, Kuopio, Finland

    Jukka A. Lipponen PhD & Mika P. Tarvainen PhD

  4. Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland

    Marja Hedman MD, PhD

  5. Heart Center, Kuopio University Hospital, Kuopio, Finland

    Antti Hedman MD, PhD & Antti Kivelä MD

Authors
  1. Saara Sillanmäki MD
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  2. Jukka A. Lipponen PhD
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  3. Mika P. Tarvainen PhD
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  9. Tomi Laitinen MD, PhD
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Correspondence to Saara Sillanmäki MD.

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Sillanmäki, S., Lipponen, J.A., Tarvainen, M.P. et al. Relationships between electrical and mechanical dyssynchrony in patients with left bundle branch block and healthy controls. J. Nucl. Cardiol. 26, 1228–1239 (2019). https://doi.org/10.1007/s12350-018-1204-0

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  • DOI: https://doi.org/10.1007/s12350-018-1204-0

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