1. Risk and predictors of dyssynchrony cardiomyopathy in left bundle branch block with preserved left ventricular ejection fraction
- Author
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Andrew Schwartzman, Sarju Ganatra, Sunita Sharma, David M. Venesy, Harsh V. Barot, Richard D. Patten, and Sachin P. Shah
- Subjects
Male ,medicine.medical_specialty ,Heart malformation ,dyssynchrony ,Population ,Bundle-Branch Block ,Cardiomyopathy ,Clinical Investigations ,heart failure ,030204 cardiovascular system & hematology ,Risk Assessment ,Ventricular Function, Left ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Medicine ,Humans ,left bundle branch block ,030212 general & internal medicine ,cardiovascular diseases ,education ,Aged ,Retrospective Studies ,education.field_of_study ,Ejection fraction ,business.industry ,Left bundle branch block ,Incidence ,Stroke Volume ,General Medicine ,medicine.disease ,United States ,Serial imaging ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies ,cardiomyopathy ,Follow-Up Studies - Abstract
Background Left bundle branch block (LBBB) and left ventricular (LV) dyssynchrony likely contribute to progressive systolic dysfunction. The evaluation of newly recognized LBBB includes screening for structural heart abnormalities and coronary artery disease (CAD). In patients whose LV ejection fraction (EF) is preserved during initial testing, the incidence of subsequent cardiomyopathy is not firmly established. Hypothesis The risk of developing LV systolic dysfunction among LBBB patients with preserved LVEF is high enough to warrant serial imaging. Methods We screened records of 1000 consecutive patients with LBBB from our ECG database and identified subjects with an initially preserved LVEF (≥45%) without clinically relevant CAD or other cause for cardiomyopathy. Baseline imaging, clinical data, and follow‐up imaging were recorded to determine the risk of subsequent LV systolic dysfunction (LVEF ≤40%). Results (Data are mean + SD) 784 subjects were excluded, the majority for CAD or depressed LVEF upon initial imaging. Of the remaining 216, 37 (17%) developed a decline in LVEF(≤40%) over a mean follow‐up of 55 ± 31 months; 94% of these patients had a baseline LVEF≤60% and LV end systolic diameter (ESD) ≥ 2.9 cm indicating that these measures may be useful to define which patients warrant longitudinal follow‐up. The negative predictive value of a LVEF>60% and LVESD
- Published
- 2020