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Left ventricular twist was decreased in isolated left bundle branch block with preserved ejection fraction [Anatol J Cardiol]
Anatol J Cardiol. 2017; 17(6): 475-480 | DOI: 10.14744/AnatolJCardiol.2017.7346  

Left ventricular twist was decreased in isolated left bundle branch block with preserved ejection fraction

Sabiye Yılmaz1, Harun Kılıç1, Mustafa Tarık Ağaç1, Nurgül Keser1, Efe Edem2, Saadet Demirtaş1, Mehmet Bülent Vatan1, Ramazan Akdemir1, Hüseyin Gündüz1
1Department of Cardiology, Faculty of Medicine, Sakarya University; Sakarya-Turkey
2Department of Cardiology, Private Tınaztepe Hospital; İzmir-Turkey

Objective: Left ventricular (LV) rotation and twist play an important role in LV contraction and relaxation. Left bundle branch block (LBBB) deteriorates both diastolic and systolic functions. We evaluated the LV twist in patients with LBBB and preserved ejection fraction (EF) (>50%) to determine twist as a potential marker for subtle myocardial dysfunction. Methods: This observational cross-sectional study included 34 LBBB patients with preserved EF who were free from ischemic and valvular disease (Group 1) and 36 healthy controls (Group 2). All patients underwent 2-D Doppler and 2-D speckle tracking echocardiography. LV apical, basal rotation, and twist were evaluated in both groups and compared accordingly. In addition, subjects were dichotomized considering the median twist value of the study population. Binary logistic regression analysis was performed to determine the independent variables associated with inframedian twist. Results: Baseline clinical characteristics were similar in LBBB patients and controls. Mean apical rotation (2.5°±1.9° vs. 4.4°±2.9°; p=0.002), basal rotation (−2.9°±2.3° vs. −4.1°±2.7°; p=0.05), and twist (5.4°±3° vs. 8.6°±3.3°; p<0.001) were decreased in group 1. Parameters related to intra- and interventricular mechanical dyssynchrony, such as longitudinal left ventricular dyssynchrony index (LVdys) and preejection interval of LV, interventricular mechanical delay (IVMD), and left posterior wall contractions (SPMWD) were significantly higher in the LBBB group. The median twist value of the studied population was 6.65°. Binary logistic regression analysis showed that only presence of LBBB was independently associated with inframedian twist (OR=6.250; 95% CI: 2.215–17.632; p<0.001). Conclusion: The LBBB might have induced the reduction of LV twist by diminishing the LV rotation before inducing a prominent effect on the left ventricular ejection fraction (LVEF). Therefore, twist may be considered as a marker for subtle LV dysfunction in LBBB with substantially normal EF.

Keywords: speckle-tracking imaging, left ventricular function, left ventricular twist, left bundle branch block

Sabiye Yılmaz, Harun Kılıç, Mustafa Tarık Ağaç, Nurgül Keser, Efe Edem, Saadet Demirtaş, Mehmet Bülent Vatan, Ramazan Akdemir, Hüseyin Gündüz. Left ventricular twist was decreased in isolated left bundle branch block with preserved ejection fraction. Anatol J Cardiol. 2017; 17(6): 475-480

Corresponding Author: Sabiye Yılmaz, Türkiye

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