A Potentially Useful Marker to Determine Left Ventricular Dysfunction in Patients with Left Bundle Branch Block with Dilated Cardiomyopathy: Tpeak-Tend

Abstract

Introduction: It has been shown in various epidemiological studies that left bundle branch block (LBBB) is an independent risk factor of cardiac mortality. In this study, we aimed to examine the relationship between left ventricular function in patients with LBBB and the Tpeak-Tend (Tp-e) interval, which can be easily measured using electrocardiography (ECG) when patients are admitted to the hospital.

Patients and Methods: In this study, 56 patients with LBBB were retrospectively selected according to their echocardiographic findings by using the retrospective scanning method. In line with this selection, patients were divided into two groups: patients with ejection fraction (EF) < 50% (32.4 ± 3.7) and those with EF > 50% (58.2 ± 4.1). Tp-e/corrected Tp-e (cTp-e) intervals were measured using the surface electrocardiogram technique.

Results: According to our results, a negative correlation between Tp-e and EF in patients with LBBB and dilated cardiomyopathy (DCMP) (r= -0.723, p= 0.0001). Tp-e had a positive correlation with left ventricular end-diastolic diameter (LVEDd) (r= 0.394, p= 0.035) and with left ventricular end-systolic diameter (LVESd) (r= 0.478, p= 0.009). In the correlation analysis, we observed a negative correlation between cTp-e and EF values (r= -0.649, p= 0.0001), and cTp-e had a positive correlation with  LVEDd (r= 0.587, p= 0.001) as well as with LVESd (r= 0.558, p= 0.002).

Conclusion: Consequently, Tp-e/cTp-e interval can be a useful parameter that can be used particularly in the determination and follow-up of the patients whose left ventricular functions have not yet been deteriorated. Furthermore, this value can be used to select patients who can benefit from the treatment and to select the optimal timing of resynchronization therapy.

Keywords

• LBBB,dilated cardiomyopathy,Tpeak-Tend,ECG

LBBB Olan Dilate Kardiyomiyopati Hastalarında Sol Ventrikül Disfonksiyonunu Belirlemek İçin Potansiyel Olarak Faydalı Bir Marker: Tpeak-Tend

Abstract

Giriş: Sol dal bloğu (LBBB)’nun birçok epidemiyolojik çalışmada kardiyak mortalitenin bağımsız bir risk faktörü olduğu gösterilmiştir. Son yapılan çalışmalarda izole LBBB’ye spesifik progresif kardiyomiyopati (KMP) gelişebileceği gösterilmiştir. Bu çalışmamızda LBBB olan hastalarda başvuru elektrokardiyografi (EKG)‘sinde kolayca ölçülebilen Tpeak-Tend (Tp-e) intervalinin sol ventrikül fonksiyonları ile ilişkisini araştırma amaçlanmıştır.

Hastalar ve Yöntem: Bu çalışmaya retrospektif tarama ile 56 LBBB hastası alınarak  ekokardiyografik değerlerine göre; EF < %50 (60.2 ± 5.6 ) ve EF > %50 (58.1 ± 7) olarak 2 gruba bölünerek incelendi. Tp-e/cTp-e intervalleri  yüzey elektrokardiyogramlarından bilgisayar ortamında hassas ölçümler elde etmek için bir dijital cetvel yardımıyla manuel olarak ölçüldü. Datalar hasta dosyalarından elde edilen ekokardiyografik parametrelerle kıyaslandı.

Bulgular: LBBB ve dilate kardiyomiyopati (DKMP) hastalarında Tp-e ile EF arasında negatif korelasyon (r= -0.723, p= 0.0001), sol ventrikül diyastol sonu çapı (SVDSÇ) arasında ise  pozitif korelasyon (r= 0.394, p= 0.035) ve sol ventrikül sistol sonu çapı (SVSSÇ) ile pozitif korelasyon (r= 0.478, p= 0.009) bulunmuştur. Korelasyon analizinde; cTp-e ile EF arasında negatif korelasyon (r= -0.649, p= 0.0001), SVDSÇ arasında ise pozitif korelasyon (r= 0.587, p= 0.001) ve SVSSÇ ile pozitif korelasyon (r= 0.558, p= 0.002)   bulunmuştur.

Sonuç: Sonuç olarak Tp-e/cTp-e intervali özellikle sol ventrikül fonksiyonları henüz bozulmamış hastaların belirlenmesinde, takibinde hatta tedaviden fayda görecek hasta seçiminde ve resenkronizasyon tedavisinin optimal zamanlamasında potansiyel olarak faydalı olabilecek bir parametre olabilir.

Keywords

• LBBB,dilate kardiyomiyopati,Tpeak-Tend,EKG

References

1. 1. Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000;102:3053-9.
2. 2. El-Menyar AA, Abdou SM. Impact of left bundle branch block and activation pattern on the heart. Expert Rev Cardiovasc Ther 2008;6:843-57.
3. 3. Vaillant C, Martins RP, Donal E, Leclercq C, Thébault C, Behar N, et al. Resolution of left bundle branch block-induced cardiomyopathy by cardiac resynchronization therapy. J Am Coll Cardiol 2013;61:1089-95.
4. 4. Pogwizd SM, McKenzie JP, Cain ME. Mechanisms underlying spontaneous and induced ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy. Circulation 1998;98:2404-14.
5. 5. Auricchio A, Fantoni C, Regoli F, Carbucicchio C, Goette A, Geller C, et al. Characterization of left ventricular activation in patients with heart failure and left bundle branch block. Circulation 2004;109:1133-9.
6. 6. Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF, et al. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation 1989;79:845-53.
7. 7. Ozdemir K, Altunkeser BB, Danis G, Ozdemir A, Uluca Y, Tokaç M, et al. Effect of the isolated left bundle branch block on systolic and diastolic functions of left ventricle. J Am Soc Echocardiogr 2001;14:1075-9.
8. 8. Larcos G, Gibbons RJ, Brown ML. Diagnostic accuracy of exercise thallium-201 single-photon emission computed tomography in patients with left bundle branch block. Am J Cardiol 1991;68:756-60.

9. 9. Koilpillai C, Quiñones MA, Greenberg B, Limacher MC, Shindler D, Pratt CM, et al. Relation of ventricular size and function to heart failure status and ventricular dysrhythmia in patients with severe left ventricular dysfunction. Am J Cardiol 1996;77: 606-11.
10. 10. Tomaselli GF, Beuckelmann DJ, Calkins HG, Berger RD, Kessler PD, Lawrence JH, et al. Sudden cardiac death in heart failure. The role of abnormal repolarization. Circulation 1994;90:2534-9.
11. 11. Okutucu, S, Oto A. Risk stratification in nonischemic dilated cardiomyopathy: Current perspectives. Cardiol J 2010;17:219-29.
12. 12. Curry CW, Nelson GS, Wyman BT, Declerck J, Talbot M, Berger RD, et al. Mechanical dyssynchrony in dilated cardiomyopathy with intraventricular conduction delay as depicted by 3-D tagged magnetic resonance imaging. Circulation 2000;101:E2.
13. 13. Smetana P, Schmidt A, Zabel M, Hnatkova K, Franz M, Huber K, et al. Assessment of repolarization heterogeneity for prediction of mortality in cardiovascular disease: Peak to the end of the T wave interval and nondipolar repolarization components. J Electrocardiol 2011;44:301-8.
14. 14. GrimmW, Christ M, Bach J, Muller HH, Maisch B. Noninvasive arrhythmia risk stratification in idiopathic dilated cardiomyopathy: results of the Marburg Cardiomyopathy Study. Circulation 2003;108:2883-91.
15. 15. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002;25:335-9.
16. 16. Oto A, Aytemir K, Köse S. Klinik kardiyak elektrofizyoloji. Ankara: Hacettepe Üniversitesi Hastaneleri Basımevi, 2004:78.
17. 17. Icli A, Kayrak M, Akilli H, Aribas A, Coskun M, Ozer SF, et al. Prognostic value of Tpeak-Tend interval in patients with acute pulmonary embolism. BMC Cardiovasc Disord 2015;15:99.
18. 18. Baldasseroni S, Gentile A, Gorini M, Marchionni N, Marini M, Masotti G, et al; Italian Network on Congestive Heart Failure Investigators. Intraventricular conduction defects in patients with congestive heart failure: left but not right bundle branch block is an independent predictor of prognosis. A report from the Italian Network on Congestive Heart Failure (IN-CHF database). Ital Heart J 2003;4:607-13.
19. 19. Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, et al. New formula for evaluation of the QT interval in patients with left bundle branch block. Heart Rhythm 2014;11:2273-7.
20. 20. Tabatabaei P, Keikhavani A, Haghjoo M, Fazelifar A, Emkanjoo Z, Zeighami M, et al. Assessment of QT and JT intervals in patients with left bundle branch block. Res Cardiovasc Med 2016;5:e31528.
21. 21. Crow RS, Hannan PJ, Folsom AR. Prognostic significance of corrected QT and corrected JT interval for incident coronary heart disease in a general population sample stratified by presence or absence of wide QRS complex: the ARIC Study with 13 years of follow-up. Circulation 2003;108:1985-9.
22. 22. Zhang ZM, Rautaharju PM, Soliman EZ, Manson JE, Cain ME, Martin LW, et al. Mortality risk associated with bundle branch blocks and related repolarization abnormalities Am J Cardiol 201215;110:1489-95.
23. 23. Zaidi M, Robert A, Fesler R, Derwael C, Brohet C.Dispersion of ventricular repolarization in dilated cardiomyopathy. Eur Heart J 1997;18:1129-34.
24. 24. Topilski I, Rogowski O, Rosso R, Justo D, Copperman Y, Glikson M, et al. The morphology of the QT interval predicts torsade de pointes during acquired bradyarrhythmias. J Am Coll Cardiol 2007;49:320-8.
25. 25. Tabrizi F, Englund A, Rosenqvist M, Wallentin L, Stenestrand U. Influence of left bundle branch block on long-term mortality in a population with heart failure. Eur Heart J 2007;28:2449-55.
26. 26. Shimizu M, Ino H, Okeie K, Yamaguchi M, Nagata M, Hayashi K, et al. T-peak to T-end interval may be a better predictor of high-risk patients with hypertrophic cardiomyopathy associated with a cardiac troponin I mutation than QT dispersion. Clin Cardiol 2002;25:335-9.
27. 27. Haarmark C, Hansen PR, Vedel-Larsen E, Pedersen SH, Graff C, Andersen MP, et al. The prognostic value of the Tpeak-Tend interval in patients undergoing primary percutaneous coronary intervention for ST-segmentelevation myocardial infarction. J Electrocardiol 2009;42:555-60.
28. 28. Luk A, Ahn E, Soor GS, Butany J. Dilated cardiomyopathy: a review. J Clin Pathol 2009;62:p219-25.
29. 29. Basaran Y, Tigen K, Karaahmet T, Isiklar I, Cevik C, Gurel E, et al. Fragmented QRS complexes are associated with cardiac fibrosis and significant intraventricular systolic dyssynchrony in nonischemic dilated cardiomyopathy patients with a narrow QRS interval. Echocardiography 2011;28:62-8.
30. 30. Das MK, Maskoun W, Shen C, Michael MA, Suradi H, Desai M, et al. Fragmented QRS on twelve-lead electrocardiogram predicts arrhythmic events in patients with ischemic and nonischemic cardiomyopathy. Heart Rhythm 2010;7:74-80.