PMID- 30497733
OWN - NLM
STAT- MEDLINE
DCOM- 20191010
LR  - 20191010
IS  - 1532-8430 (Electronic)
IS  - 0022-0736 (Linking)
VI  - 51
IP  - 6
DP  - 2018 Nov-Dec
TI  - Ejection fraction in left bundle branch block is disproportionately reduced in 
      relation to amount of myocardial scar.
PG  - 1071-1076
LID - S0022-0736(18)30108-0 [pii]
LID - 10.1016/j.jelectrocard.2018.09.009 [doi]
AB  - INTRODUCTION: The relationship between left ventricular (LV) ejection fraction 
      (EF) and LV myocardial scar can identify potentially reversible causes of LV 
      dysfunction. Left bundle branch block (LBBB) alters the electrical and mechanical 
      activation of the LV. We hypothesized that the relationship between LVEF and scar 
      extent is different in LBBB compared to controls. METHODS: We compared the 
      relationship between LVEF and scar burden between patients with LBBB and scar 
      (n = 83), and patients with chronic ischemic heart disease and scar but no 
      electrocardiographic conduction abnormality (controls, n = 90), who had undergone 
      cardiovascular magnetic resonance (CMR) imaging at one of three centers. LVEF (%) 
      was measured in CMR cine images. Scar burden was quantified by CMR late 
      gadolinium enhancement (LGE) and expressed as % of LV mass (%LVM). Maximum 
      possible LVEF (LVEFmax) was defined as the function describing the hypotenuse in 
      the LVEF versus myocardial scar extent scatter plot. Dysfunction index was 
      defined as LVEFmax derived from the control cohort minus the measured LVEF. 
      RESULTS: Compared to controls with scar, LBBB with scar had a lower LVEF (median 
      [interquartile range] 27 [19-38] vs 36 [25-50] %, p < 0.001), smaller scar (4 
      [1-9] vs 11 [6-20] %LVM, p < 0.001), and greater dysfunction index (39 [30-52] vs 
      21 [12-35] % points, p < 0.001). CONCLUSIONS: Among LBBB patients referred for 
      CMR, LVEF is disproportionately reduced in relation to the amount of scar. 
      Dyssynchrony in LBBB may thus impair compensation for loss of contractile 
      myocardium.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Axelsson, Jimmy
AU  - Axelsson J
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden.
FAU - Wieslander, Bjorn
AU  - Wieslander B
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden.
FAU - Jablonowski, Robert
AU  - Jablonowski R
AD  - Department of Clinical Physiology and Nuclear Medicine, Skane University 
      Hospital, Lund University, Lund, Sweden.
FAU - Klem, Igor
AU  - Klem I
AD  - Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
FAU - Nijveldt, Robin
AU  - Nijveldt R
AD  - Department of Cardiology, VU University Medical Center, Amsterdam, the 
      Netherlands.
FAU - Schelbert, Erik B
AU  - Schelbert EB
AD  - University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
FAU - Sorensson, Peder
AU  - Sorensson P
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden; Department of Cardiology, Karolinska 
      University Hospital, Stockholm, Sweden.
FAU - Sigfridsson, Andreas
AU  - Sigfridsson A
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden.
FAU - Chaudhry, Uzma
AU  - Chaudhry U
AD  - Arrhythmia Clinic, Skane University Hospital, Department of Cardiology, Clinical 
      Sciences, Lund University, Lund, Sweden.
FAU - Platonov, Pyotr G
AU  - Platonov PG
AD  - Arrhythmia Clinic, Skane University Hospital, Department of Cardiology, Clinical 
      Sciences, Lund University, Lund, Sweden.
FAU - Borgquist, Rasmus
AU  - Borgquist R
AD  - Arrhythmia Clinic, Skane University Hospital, Department of Cardiology, Clinical 
      Sciences, Lund University, Lund, Sweden.
FAU - Engblom, Henrik
AU  - Engblom H
AD  - Department of Clinical Physiology and Nuclear Medicine, Skane University 
      Hospital, Lund University, Lund, Sweden.
FAU - Strauss, David G
AU  - Strauss DG
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden; US Food and Drug Administration, Silver 
      Spring, MD, USA.
FAU - Arheden, Hakan
AU  - Arheden H
AD  - Department of Clinical Physiology and Nuclear Medicine, Skane University 
      Hospital, Lund University, Lund, Sweden.
FAU - Atwater, Brett D
AU  - Atwater BD
AD  - Division of Cardiology, Duke University Medical Center, Durham, NC, USA.
FAU - Ugander, Martin
AU  - Ugander M
AD  - Department of Clinical Physiology, Karolinska Institutet, and Karolinska 
      University Hospital, Stockholm, Sweden. Electronic address: martin@ugander.com.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
DEP - 20180917
PL  - United States
TA  - J Electrocardiol
JT  - Journal of electrocardiology
JID - 0153605
SB  - IM
EIN - J Electrocardiol. 2019 Mar - Apr;53:115. PMID: 30661715
MH  - Aged
MH  - Bundle-Branch Block/complications/*physiopathology
MH  - Cicatrix/*complications/physiopathology
MH  - Cross-Sectional Studies
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/physiopathology
MH  - Myocardium/*pathology
MH  - Retrospective Studies
MH  - *Stroke Volume
OTO - NOTNLM
OT  - *Left bundle branch block
OT  - *Left ventricular ejection fraction
OT  - *Magnetic resonance imaging
OT  - *Myocardial scarring
EDAT- 2018/12/01 06:00
MHDA- 2019/10/11 06:00
CRDT- 2018/12/01 06:00
PHST- 2018/07/25 00:00 [received]
PHST- 2018/09/09 00:00 [revised]
PHST- 2018/09/15 00:00 [accepted]
PHST- 2018/12/01 06:00 [entrez]
PHST- 2018/12/01 06:00 [pubmed]
PHST- 2019/10/11 06:00 [medline]
AID - S0022-0736(18)30108-0 [pii]
AID - 10.1016/j.jelectrocard.2018.09.009 [doi]
PST - ppublish
SO  - J Electrocardiol. 2018 Nov-Dec;51(6):1071-1076. doi: 
      10.1016/j.jelectrocard.2018.09.009. Epub 2018 Sep 17.