Background Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine-atropine stress echocardiography in left bundle branch block patients. Methods and ResultsSixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine-atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis d50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration d160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/ 15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%).Conclusions Dobutamine-atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine-atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine-atropine stress echocardiography may initially be selected by their resting electrocardiogram.

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Funding Acknowledgements Type of funding sources: None. Despite the fact that most people with COVID-19 (C-19) do not require hospitalization, little is known about the changes in ECG in this group of patients (pts). The electrocardiogram (ECG) is one of the leading tools to assess the extent of cardiac involvement in C-19 pts. Our main aim was to asses ECG abnormalities related to cardiac involvement in patients without hospitalization with mild and moderate course of C-19 . Methods Only pts without  co morbidities, not taking any medications were included to the study.  In all pts  standard 12-lead electrocardiograms (EKG)  mean 8,2week +/- 4,6) after C-19 was  performed in supine position after 15 minutes in rest.  The following parameters were analyzed: mean heart rate (mHR), bradycardia and tachycardia episodes defined as HR <40bpm and  HR> 100 bpm, PQ duration, QRS durations,  the Bazett-corrected QT interval, changes in the ST-T segment and the T wave. Additionally heart rhythm disturbances were assessed and atrial fibrillation/flutter episodes, the presence of atrial premature contractions (APCs), ventricular premature contractions VES) Number of atrioventricular blocks, bundle branch blocs (BBB) – (RBBB, LBBB, a nonspecific intraventricular conduction block) were also analyzed. Results 264 pts were included to final assessment, with mean age 43,5 ± 13,5 years. The results were as follow: HR <40bpm - in 0pts, HR> 100 bpm in 9(3%)pts, PQ duration > 200ms in 7(3%)pts, QRS durations > 100ms in 19(6%)pts, QTc interval in 16 (6%)pts, ST-T segment abnormalities in 21(8%)pts and the T wave abnormalities in16(6%)pts Following heart rhythm disturbances were noted: AF/AFl in 0pts, (APCs) in 0pts, VES – in 3(1%)pts. No episodes of atrioventricular blocks were recorded, but BB in bundle branch blocs (BBB) – (RBBB, LBBB, a nonspecific intraventricular conduction block)  in 14 (3%) pts were noted. Conclusions. The most frequent ECG abnormalities in pts without co-morbidities after COVID-19 without hospitalization were ST-T segment and T abnormalities. A large number of changes in ECG confirms that we can expect cardiac involvement also in the group of patients with mild and moderate course of COVID-19.

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