Prolonged QRS duration (QRS ≥170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?

Das, Mithilesh K.; Cheriparambil, Kuruvilla; Bedi, Ashwini; Kassotis, John; Reddy, C.V.R.; Makan, Majesh; Dunbar, Christopher; Saul, Barry I.

doi:10.1067/mhj.2001.118735

Cited by 47 publications

(31 citation statements)

References 12 publications

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“…Prolonged QRS duration in the presence of LBBB has been known to be predictor for poor LV systolic function (22). This, however, could not be stated for prolonged QRS in RBBB (23).…”

Section: Discussionmentioning

confidence: 61%

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Devarapally

Arora

Ahmad

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Right ventricular (RV) failure has proven to be independently associated with adverse outcomes. Electrocardiographic parameters assessing RV function are largely unknown, making echocardiography the first line for RV function assessment. It is however, limited by geometrical assumptions and is inferior to cardiac magnetic resonance imaging (CMRI) which is widely regarded as the most accurate tool for assessing RV function. Methods:We seek to determine the correlation of ECG parameters of right bundle branch block (RBBB) with RV ejection fraction (EF) and RV dimensions using the CMRI. QRS duration, R amplitude and R' duration were obtained from precordial lead V1; S duration and amplitude were obtained from lead I and AVL. RV systolic dysfunction was defined as RV EF <40%. RV systolic dysfunction group (mean EF of 24±10%) were compared with normal RV systolic function group which acted as control (mean EF of 48±8%). CMRI and ECG parameters were compared between the two groups. Rank correlations and scatter diagrams between individual CMRI parameters and ECG parameters were done using medcalc for windows, version 12.5. Sensitivity, specificity and area under the curve (AUC) were calculated.Results: RV systolic dysfunction group was found to have larger RV end systolic volumes (90±42 vs. 59±40 mL, P=0.02). ECG evaluation of RV dysfunction group revealed longer R' duration (103±22 vs.84±18 msec, P=0.005) as compared to the control group. The specificity of R' duration >100 msec to detect RV systolic dysfunction was found to be 93%. R' duration was found to have an inverse correlation with RV EF (r=−0.49, P=0.007).Conclusions: Larger RV end systolic volumes seen with RV dysfunction can affect the latter part of right bundle branch leading to prolonged R' duration. We here found prolonged R' duration in lead V1 to have a highly specific inverse correlation to RV systolic function. ECG can be used as an inexpensive tool for RV function assessment and should be used alongside echocardiography to evaluate RV dysfunction when CMRI is not available.

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“…Prolonged QRS duration in the presence of LBBB has been known to be predictor for poor LV systolic function (22). This, however, could not be stated for prolonged QRS in RBBB (23).…”

Section: Discussionmentioning

confidence: 61%

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Devarapally

Arora

Ahmad

et al. 2016

Cardiovasc. Diagn. Ther.

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“…A number of studies have noted an inverse relationship between the ejection fraction and QRS duration [22][23][24][25][26]. However, only one study performed a multivariate analysis to determine the predictors of LBBB [23].…”

Section: Discussionmentioning

confidence: 97%

Epidemiological and evolutionary characteristics of heart failure in patients with left bundle branch block – A Moroccan center-based study

Bouqata¹,

Kheyi²,

Miftah³

et al. 2015

Journal of the Saudi Heart Association

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“…In the presence of LBBB, the QRS duration has been shown to have a significant inverse relationship with EF, and QRS duration greater than 170 ms is said to be a marker of significant LV systolic dysfunc- tion [17]. The diagnostic evaluation of patients with isolated LBBB is challenging.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic markers of left ventricular systolic dysfunction in patients with left bundle branch block

et al. 2016

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A b s t r a c tBackground: Although some patients with left bundle branch block (LBBB) have structural heart diseases, some patients with LBBB have "normal hearts". The electrocardiography (ECG) criteria of LBBB in reduced left ventricular ejection fraction (LVEF) have not been defined completely. Aim:The main purpose of this study was to differentiate patients with reduced LVEF from patients with normal left ventricular systolic function simply by analysing 12-lead ECG.Methods: Subjects admitted to our hospital with LBBB in their ECG were included in the study. The patients were categorised according to their left ventricular systolic function as group 1 (LVEF ≥ 50%) and group 2 (LVEF < 50%). Duration of the QRS complex, residual conduction of left bundle branch, and concordance/discordance of T waves in leads V5, V6, or D1 were recorded. The ECG findings of the two groups were compared. Results:One hundred consecutive patients with LBBB were included in the study (male/female: 56/44, age: 66 ± 15 years). In the whole group, there were 35 patients with normal left ventricular systolic function (LVEF ≥ 50%), and 65 patients had LVEF below 50%. 80% of male patients with LBBB and 45% of female patients with LBBB had their LVEF below 50% (p < 0.001). Mean QRS durations of group 1 and group 2 were 132 ± 10 ms vs. 152 ± 22 ms, respectively (p < 0.001). The QRS duration of 140 ms was found to be the cut-off value to differentiate group 1 from group 2, with sensitivity and specificity of 72% and 75%, respectively. Twenty-one per cent of patients in group 1 and 69% in group 2 had discordant LBBB (p < 0.001). Residual conduction of left bundle branch was more frequent in group 2 (29% in group 1 vs. 52% in group 2, p = 0.03). Conclusions:Male gender, QRS duration greater than 140 ms, discordant LBBB, and residual conduction in the left bundle branch seem to be markers of reduced LVEF in patients with LBBB.

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Prolonged QRS duration (QRS ≥170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?

Cited by 47 publications

References 12 publications

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Epidemiological and evolutionary characteristics of heart failure in patients with left bundle branch block – A Moroccan center-based study

Electrocardiographic markers of left ventricular systolic dysfunction in patients with left bundle branch block

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