Algamal, A., Salem, M., Abdel Shakour, H., Elhusseiny, S. (2022). Left Bundle Branch Block: What Does it Hide? Clinical, Echocardiographic, and Angiographic Study. Suez Canal University Medical Journal, 25(3), 66-76. doi: 10.21608/scumj.2022.264318
Abdulsalam M. Algamal; Mahmoud A. Salem; Hany M. Abdel Shakour; Shady H. Elhusseiny. "Left Bundle Branch Block: What Does it Hide? Clinical, Echocardiographic, and Angiographic Study". Suez Canal University Medical Journal, 25, 3, 2022, 66-76. doi: 10.21608/scumj.2022.264318
Algamal, A., Salem, M., Abdel Shakour, H., Elhusseiny, S. (2022). 'Left Bundle Branch Block: What Does it Hide? Clinical, Echocardiographic, and Angiographic Study', Suez Canal University Medical Journal, 25(3), pp. 66-76. doi: 10.21608/scumj.2022.264318
Algamal, A., Salem, M., Abdel Shakour, H., Elhusseiny, S. Left Bundle Branch Block: What Does it Hide? Clinical, Echocardiographic, and Angiographic Study. Suez Canal University Medical Journal, 2022; 25(3): 66-76. doi: 10.21608/scumj.2022.264318
Left Bundle Branch Block: What Does it Hide? Clinical, Echocardiographic, and Angiographic Study
Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Abstract
Background: In patients with left bundle branch block (LBBB), prediction of obstructive coronary artery disease (OCAD) could select patients indicated for coronary angiography (CA). Aim: Evaluate clinical and echocardiographic features, angiographic patterns, and non-invasive predictors of OCAD in subjects with LBBB. Subjects and Methods: Patients with LBBB underwent clinical assessment, detailed echocardiography, and elective CA. We recruited 68 patients with OCAD and 44 patients with normal CA (NCA), both groups were age- and sex-matched. Results: Patients with OCAD compared to the NCA group had significantly higher CHA2DS2-VASc-HSF scores, diabetes mellitus, dyslipidemia, fragmented wide QRS complex, concordant STT changes, and left ventricular mass index. Heart failure affected 32 (28.57%) of our patients with no significant difference between both groups. Conventional echocardiography and tissue Doppler imaging showed no significant differences between both groups regarding parameters of systolic and diastolic functions as ejection fraction, and the ratio of late diastolic transmitral flow velocity (E) to early diastolic mitral annular tissue velocity (E/E` ratio). Whereas Speckle tracking echocardiography (STE) showed a significantly lower early global diastolic strain rate (E`sr), higher E/E`sr ratio, and worse global longitudinal strain (GLS). Independent predictors of OCAD in patients with LBBB included CHA2DS2-VASc-HSF score > 3.5, QRS duration > 148.5 milliseconds, E/E`sr ratio > 171.31 centimeter, and GLS worse than -14.5%. Conclusion: Systolic and diastolic dysfunction and the predictors of OCAD in patients with LBBB were better evaluated by STE. Clinical assessment and non-invasive imaging of patients with LBBB would help to select patients who need invasive strategies.
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