Heart remodeling in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block
DOI:
https://doi.org/10.14739/2310-1210.2018.3.130847Keywords:
ventricular remodeling bundle-branch block, myocardial infarctionAbstract
The prevalence of left bundle branch block (LBBB) in the general population is 0.1–0.8 %, and in patients with ST-segment elevation Q-wave myocardial infarction (Q-MI) varies from 1 % to 15 %.
The aim - to evaluate the structural and functional features of the heart in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block.
Materials and methods. The study involved 60 patients with Q-MI (40 men and 20 women), who were hospitalized in cardiology department for patients with myocardial infarction treatment of Zaporizhzhіa City Emergency and Urgent Care Clinic. Patients were divided into two groups: 40 patients with Q-MI and the LBBB (the mean age was 71.53 ± 1.23 years), 20 patients with Q-MI without LBBB (the mean age was 65.47 ± 2.25 years). Assessment of intracardiac hemodynamics were performed by echocardiography using a “MyLab50” (“Esaote”,Italy) ultrasound system on the recommendations of the American Society of Echocardiography.
Results. Patients with acute Q-MI with LBBB were significantly older than patients who had acute Q-MI without LBBB (9.2 %, P < 0.05). Patients with anterior acute Q-MI prevailed among persons with LBBB (75 %). Thickening of the posterior wall (by 9.6 %; P < 0.05), an increase in LVMMI (by 11.2 %; P < 0.05), an increase in end-diastolic size (by 12.9 %; P < 0.05) and end-systolic size (by 18.6 %; P < 0.05); acceleration of MVE (by 18.3 %; P < 0.05); and an increase systolic pressure in the pulmonary artery (by 23.1 %; P < 0.05) were found in patients with Q-MI with LBBB compared to patients with Q-MI without LBBB. The analysis of contingency table revealed significant association between LBBB presence in patients with Q-MI and diabetes mellitus (χ2 = 4.53; P < 0.05), female gender (χ2 = 3.87; P < 0.05) and age over 65 years (χ2 = 5.71; P < 0.05). In patients with acute Q-MI and LBBB a significant positive correlation between the QRS width and end-diastolic size (+0.49; P < 0.05), end-systolic size (+0.45; P < 0.05), systolic pressure in pulmonary artery (+0.31; P < 0.05) and diastolic size of right ventricle (+0.38; P < 0.05), and a negative correlation between the QRS width and ejection fraction (-0.71; P < 0.05) and IVRT (-0.37; P < 0.05) were noted.
Conclusions. LBBB in patients with acute Q-MI is associated with female gender, age over 65 years and past history of diabetes mellitus. Acute Q-MI in the presence of LBBB is characterized by eccentric hypertrophy with an increase in the left ventricular size and pulmonary hypertension. QRS complex duration in patients with acute Q-MI and LBBB is associated with systolic function deterioration, left ventricular dilatation and pulmonary hypertension.
References
Zhuravleva, L. V., & Yankevich, A. A. (2010) Klinicheskoe i prognosticheskoe znachenie blokady levoj nozhki puchka Gisa [Clinical and prognostic value of left bundle branch blockade]. Liky Ukrainy, 33, 132–138. [in Russian].
Revishvili, A. Sh., & Neminushchii, N. M. (2007) Serdechnaya resinkhroniziruyushchaya terapiya v lechenii khronicheskoj serdechnoy nedostatochnosti [Cardiac resynchronizing therapy in treatment of chronic heart failure]. Vestnik aritmologii, 48, 47–57. [in Russian].
Kovalenko, V. I., Lutai, M. I., & Sirenko, Yu. M. (Eds.) (2016) Sertsevo-sudynni zakhvoriuvannia Klasyfikatsiia, standarty diahnostyky ta likuvannia [Cardiovascular diseases. Classification, standards of diagnosis and treatment]. Kyiv. [in Ukrainian].
Amsterdam, E. A., Wenger, N. K., Brindis, R. G., Casey, D. E. Jr., Ganiats, T. G., Holmes, D. R. Jr., et al. (2014) 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Amsterdam. J Am. Coll. Cardio., 64(24), e139–e228. doi: 10.1016/j.jacc.2014.09.017.
Cabrera, E., & Friedland, C. (1953) La onda de activacion ventricular en el bloqueo deramaizquierda con infarto: unnuevo signo electrocardiografico. Arch. Inst. Cardiol. Mex., 23, 441–460.
El-Chami, M. F., Brancato, C., Langberg, J., Delurgio, D. B., Bush, H., Brosius, L., & Leon, A. R. (2010) QRS duration is associated with atrial fibrillation in patients with left ventricular dysfunction. Clin Cardiol., 33(3), 132–138. doi: 10.1002/clc.20714.
Francia, P., Balla, C., Paneni, F., & Volpe, M. (2007) Left Bundle-Branch Block. Clin. Cardiol., 30, 110–115. doi: 10.1002/clc.20034.
Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., et al. (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1–39. doi: 10.1016/j.echo.2014.10.003.
Nagueh, S. F., Smiseth, O. A., Appleton, C. P., Byrd, B. F., Dokainish, H., Edvardsen, T., et al. (2016) Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography., 29, 277–314. doi: 10.1016/j.echo.2016.01.011.
Roffi, M., Patrono, C., Collet, J. P., Mueller, C., Valgimigli, M., Andreotti, F., et al. (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology. European Heart Journal, 37, 267–315. doi: 10.1093/eurheartj/ehv320.
Schneider, J. F., Thomas, H. E. Jr, Sorlie, P., Kreger, B. E., McNamara, P. M., & Kannel, W. B. (1981) Comparative features of newly acquired left and right bundle branch block in the general population: the Framingham study. Am. J. Cardiol., 47, 931–940. doi: 10.1016/0002-9149(81)90196-X.
Sgarbossa, E. B., Pinski, S. L., Barbagelata, A., Underwood, D. A., Gates, K. B., Topol, E. J., et al. (1996) Electrocardiographic diagnosis of evolving myocardial infarction in the presence of left bundle branch block. N Engl J Med., 334, 481–487. doi: 10.1056/NEJM199602223340801.
Stenestrand, U., Tabrizi, F., Lindback, J., et al. (2004) Comorbidity and myocardial dysfunction are the main explanations for the higher 1 -year mortality in acute myocardial infarction with left bundlebranch block. Circulation., 110, 1896–1902.
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