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- Title
The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling.
- Authors
Dobson, Laura E.; Musa, Tarique A.; Uddin, Akhlaque; Fairbairn, Timothy A.; Bebb, Owen J.; Swoboda, Peter P.; Haaf, Philip; Foley, James; Garg, Pankaj; Fent, Graham J.; Malkin, Christopher J.; Blackman, Daniel J.; Plein, Sven; Greenwood, John P.
- Abstract
Background: Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. Methods: 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. Results: In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m², p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. Conclusion: TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population. Keywords: Aortic valve stenosis, Trans-catheter aortic valve implantation, Left bundle branch block, Ventricular ejection fraction, Ventricular remodeling, Cardiovascular magnetic resonance
- Subjects
BUNDLE-branch block; SURGICAL complications; HEART ventricle diseases; ANTHROPOMETRY; AORTIC stenosis; CHI-squared test; ELECTROCARDIOGRAPHY; LEFT heart ventricle; PROSTHETIC heart valves; MAGNETIC resonance imaging; PROBABILITY theory; REGRESSION analysis; RESEARCH funding; STATISTICS; T-test (Statistics); DATA analysis; MULTIPLE regression analysis; VENTRICULAR remodeling; PRE-tests &; post-tests; CONTRAST media; DATA analysis software; DESCRIPTIVE statistics; MANN Whitney U Test; VENTRICULAR ejection fraction; DIAGNOSIS
- Publication
Journal of Cardiovascular Magnetic Resonance (BioMed Central), 2017, Vol 19, p1
- ISSN
1532-429X
- Publication type
Article
- DOI
10.1186/s12968-017-0335-9