Paradoxical Motion of Interventricular Septum in Left Bundle Branch Block

Abbasi, Abdul S.; Eber, Leslie M.; MacAlpin, Rex N.; Kattus, Albert A.

doi:10.1161/01.cir.49.3.423

Cited by 101 publications

(29 citation statements)

References 16 publications

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“…Likewise, the proximal or more distal site of left bundle branch block may influence septal motion and thickening [15] . In contrast to the initial studies describing septal motion [11][12][13] , many left bundle branch block patients in the present study had (apart from the early systolic notch) relatively normal septal motion and thickening. In particular, patients without evidence of coronary artery disease or cardiomyopathy usually had normal septal motion and thickening.…”

Section: Echocardiographic Characteristics Of Left Bundle Branch Blockcontrasting

confidence: 97%

“…During simultaneous right and left ventricular ejection several types of septal motion can be encountered. Classically, septal motion is anterior and described as paradoxical [11][12][13] ; however, normal posterior motion and several intermediate types may also occur [11][12][13][14][15][16] . Septal motion seems related to both contraction capability (e.g.…”

Section: Echocardiographic Characteristics Of Left Bundle Branch Blockmentioning

confidence: 99%

“…Classically, septal motion is anterior and described as paradoxical [11][12][13] . However, normal posterior motion and several intermediate types may also occur [11][12][13][14][15][16] . Dobutamine-atropine stress echocardiography is an established stress modality for the detection of coronary artery disease in patients without left bundle branch block [17] .…”

Section: Introductionmentioning

confidence: 99%

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Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Geleijnse

Vigna

Kasprzak

et al. 2000

European Heart Journal

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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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Section: Echocardiographic Characteristics Of Left Bundle Branch Blockcontrasting

confidence: 97%

Section: Echocardiographic Characteristics Of Left Bundle Branch Blockmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Geleijnse

Vigna

Kasprzak

et al. 2000

European Heart Journal

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“…As a result, the septal movement becomes sensitive to the pressure gradient between right and left ventricles [40]. This passive pressure-driven septal movement is known as paradoxical movement.…”

Section: Regional Intraventricular Dyssynchronymentioning

confidence: 99%

“…a dynamic window in the cross-correlation analysis for the extraction of coherent contraction timings. As a result, only active septal movements are processed, while passive paradoxical movements of the septum are excluded [40], [41].…”

mentioning

confidence: 99%

Quantification of Regional Left Ventricular Dyssynchrony by Magnetic Resonance Imaging

Mischi

Bosch²,

Jansen

et al. 2008

IEEE Trans. Biomed. Eng.

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Abstract-Cardiac resynchronization therapy is an established treatment in patients with symptomatic heart failure and intraventricular conduction delay. Electrical dyssynchrony is typically adopted to represent myocardial activation dyssynchrony, which should be compensated by cardiac resynchronization therapy. One third of the patients, however, does not respond to the therapy. Therefore, imaging modalities aimed at the mechanical dyssynchrony estimation have been recently proposed to improve patient selection criteria. This paper presents a novel fully automated method for regional mechanical left ventricular dyssynchrony quantification in short-axis magnetic resonance imaging. The endocardial movement is described by time-displacement curves with respect to an automatically determined reference point. Different methods are proposed for time-displacement curve analysis aimed at the regional contraction timing estimation. These methods were evaluated in two groups of subjects with (nine patients) and without (six patients) left bundle branch block. The contraction timing standard deviation showed a significant increase for left bundle branch block patients with all the methods. A novel method based on phase spectrum analysis may be however preferred due to a better specificity (99.7%) and sensitivity (99.0%). In conclusion, this method provides a valuable prognostic indicator for heart failure patients with dyssynchronous ventricular contraction and it opens new possibilities for regional timing analysis.Index Terms-Biomedical measurement, cardiology, magnetic resonance imaging (MRI), medical image processing.

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Intermittent Left Bundle Branch Block and Associated T-Wave Abnormalities

Michelotti¹

1985

Arch Intern Med

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Paradoxical Motion of Interventricular Septum in Left Bundle Branch Block

Cited by 101 publications

References 16 publications

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Usefulness and limitations of dobutamine–atropine stress echocardiography for the diagnosis of coronary artery disease in patients with left bundle branch block. A multicentre study

Quantification of Regional Left Ventricular Dyssynchrony by Magnetic Resonance Imaging

Intermittent Left Bundle Branch Block and Associated T-Wave Abnormalities

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