Aspects of Left Ventricular Morphology Outperform Left Ventricular Mass for Prediction of QRS Duration

Hakacova, Nina; Steding, Katarina; Engblom, Henrik; Sjögren, Jane; Maynard, Charles; Pahlm, Olle

doi:10.1111/j.1542-474x.2010.00352.x

Cited by 13 publications

(13 citation statements)

References 23 publications

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“…The correlation between papillary muscle angle and QRSd in healthy patients 1 was not present in cardiomyopathy patients. Figure 3A shows electrical activation in normal conduction patients starting in the endocardium and papillary muscles.…”

Section: Discussionmentioning

confidence: 77%

“…Previous studies in healthy subjects with normal conduction demonstrated that LV mass, 2,1 LV length 1 , LV diameter, 2 and LV wall thickness 2 all correlated with QRSd. Our findings are also consistent with results of previous studies in patients with known cardiovascular disease, where QRS duration was associated with LV mass and LVEDV.…”

Section: Discussionmentioning

confidence: 88%

“…Papillary muscle angle was measured as previously described, in the short axis view in the plane where the papillary muscle inserts into the LV wall (Figure 1B). 5,1 LV diameter and wall thicknesses were measured at this level at end-diastole. LV length was measured from the four-chamber long axis view (Figure 1A).…”

Section: Methodsmentioning

confidence: 99%

“…Prior work in healthy subjects demonstrated that left ventricular (LV) mass, length, and papillary muscle location predicted QRSd. 1 Previous studies also showed that QRSd prolongation is associated with LV structural changes including increases in wall thickness. 2,3,4 Other anatomical factors that influence QRSd include fiber orientation, LV geometry, the complexity of the Purkinje network, and the shape of the LV wall.…”

Section: Introductionmentioning

confidence: 96%

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Comparison of the Relation Between Left Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block

Chan

Loring

et al. 2014

The American Journal of Cardiology

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QRS duration (QRSd) is used to diagnose left bundle branch block (LBBB) and is important for determining cardiac resynchronization therapy eligibility. The same QRSd thresholds established decades ago are used for all patients. However, significant inter-individual variability of normal QRSd exists and individualized QRSd thresholds may improve diagnosis and intervention strategies. Prior work reported left ventricular (LV) mass and papillary muscle location predicted QRSd in healthy subjects, but the relationship in diseased ventricles is unknown. We aimed to determine the association between LV anatomy and QRSd in cardiomyopathy patients. Patients referred for primary prevention implantable defibrillators (n=166) received cardiac magnetic resonance imaging and those with normal conduction (without bundle branch or fascicular block) and LBBB were studied. LV mass, length, internal diameter, end diastolic volume (LVEDV), septal and lateral wall thickness, and papillary muscle location were measured. In normal conduction patients, LV length (r=0.35, p<0.001), mass (r=0.32, p<0.001), diameter (r=0.20, p=0.03) and septal wall thickness (r=0.20, p=0.03) had positive correlations with QRSd. In LBBB patients, LV length (r=0.32, p=0.03), mass (r=0.39, p=0.01), diameter (r=0.34, p=0.02), and LVEDV (r=0.32, p=0.04) had positive correlations with QRSd. Contrary to prior studies in healthy subjects, papillary muscle angle (location) was not associated with QRSd in normal conduction or LBBB cardiomyopathy patients. In conclusion, increasing LV anatomical measurements are associated with increasing QRSd in cardiomyopathy patients. Future work should investigate the use of LV anatomical measurements in developing individualized QRSd thresholds for diagnosing conduction abnormalities such as LBBB and identifying candidates for cardiac resynchronization therapy.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

See 2 more Smart Citations

Comparison of the Relation Between Left Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block

Chan

Loring

et al. 2014

The American Journal of Cardiology

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“…Ez csak egy kisebb, egyetlen vizsgáló-helyen igazolt eredmény, amelyet nyilván nagyobb, multicentrikus vizsgálatokban is igazolni szükséges. A legfrissebb vizsgálatok arra is utalnak, hogy a digitalizált EKG-feldolgozás numerikus adatai alkalmasak lehetnek a bal kamrai űrtér és morfológia egyéni különb-ségeinek normalizálására, azaz az úgynevezett "esetspecifi kus" QRS-időtartam meghatározására [27], amely tovább pontosíthatja a CRT indikációját.…”

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Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

Préda

2013

Orvosi Hetilap

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A jelenleg érvényes irányelvek szerint szisztolés szívelégtelenség New York Heart Association II-IV. osztályaiban, ha a bal kamra ejekciós frakciója ≤35%, a QRS-komplexus ≥120 ms és az EKG bal-Tawara-szár-blokkot mutat, biventricularis pacemakerkezelés indikált. A szív reszinkronizációs kezelése és korábbi humán elektrofi ziológiai és patológiai adatok újraértelmezése azt mutatja, hogy ha a bal-Tawara-szár-blokkban mért QRS szélessége ≤130 ms (nőkben), illetve ≤140 ms (férfi akban), nem beszélhetünk valódi bal-Tawara-szár-blokkról. Ez utóbbiban az aszinkrón bal kamra-aktiváció jellemzője nőkben ≥130 ms, férfi akban ≥140 ms QRS-idő, a depolarizáció kezdetét >40 ms-mal követő csomós, kettős megtöretést mutató R-hullám az I, aVL és V 1 , V 2 , V 5 és V 6 EKG-elvezetés közül legalább kettőben, a korábban dokumentált nem szárblokkos ingerületvezetéshez képest ≥40 ms késés, ami hirtelen jön létre. Lassan, folyamatosan szélesedő bal-Tawara-szár-blokk-"szerű" QRS-komplexus bal mellső hemiblokk és hypertrophia együttesére vagy metabolikus/infi ltratív kóreredetre utal. Orv. Hetil., 2013, 154, 688-693. Kulcsszavak: szisztolés szívelégtelenség, szívreszinkronizációs kezelés (CRT), MADIT-CTR vizsgálat, bal-Tawaraszár-blokk-morfológia Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch blockIf New York Heart Association Class II-IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic fi ndings in left bundle branch block provided evidence that "true" left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In "true" left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V 1, V 2 , V 5 and V 6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened "left bundle branch block like" QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infi ltrative disease. Orv. Hetil., 2013, 154, 688-693. Keywords: systolic heart failure, cardiac resynchronization therapy (CRT), MADIT-CRT study, morphology of left bundle branch block (Beérkezett: 2013. március 4.; elfogadva: 2013. március 28.) Rövidítések BTSzB = bal-Tawara-szár-blokk; CRT = (cardiac resynchronization therapy) szívreszinkronizációs kezelés; EF = ejekciós frakció; NYHA = New York Heart Association

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Importance of defining left bundle branch block

Strauss

2012

Journal of Electrocardiology

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Aspects of Left Ventricular Morphology Outperform Left Ventricular Mass for Prediction of QRS Duration

Abstract: The model for prediction of QRS duration opens the ability to predict case-specific normal QRS duration. This knowledge can have clinical importance, when determining the normality on case-specific basis.

Cited by 13 publications

References 23 publications

Comparison of the Relation Between Left Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block

Comparison of the Relation Between Left Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block

Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

Importance of defining left bundle branch block

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