The impact of trans-catheter aortic valve replacement induced left-bundle branch block on cardiac reverse remodeling

• Published in: Journal of cardiovascular magnetic resonance Vol. 19; no. 1; p. 22
• Main Authors: Dobson, Laura E, Musa, Tarique A, Uddin, Akhlaque, Fairbairn, Timothy A, Bebb, Owen J, Swoboda, Peter P, Haaf, Philip, Foley, James, Garg, Pankaj, Fent, Graham J, Malkin, Christopher J, Blackman, Daniel J, Plein, Sven, Greenwood, John P
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.02.2017; BioMed Central
• Subjects: Action Potentials; Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic valve stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Biomechanical Phenomena; Bundle-Branch Block - diagnostic imaging; Bundle-Branch Block - etiology; Bundle-Branch Block - physiopathology; Bundling; Cardiac patients; Care and treatment; Catheters; Correlation; Diagnosis; Electrocardiography; Female; Health aspects; Heart Rate; Humans; Magnetic resonance; Magnetic Resonance Imaging; Male; Mortality; Myocardial Contraction; Patients; Prevention; Remodeling; Retrospective Studies; Severity of Illness Index; Stress, Mechanical; Stroke Volume; Time Factors; Tracking; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Valves; Ventricular Function, Left; Ventricular Remodeling; Left bundle branch block; Ventricular remodeling; Trans-catheter aortic valve implantation; Cardiovascular magnetic resonance; Aortic valve stenosis; Ventricular ejection fraction
• ISSN: 1097-6647; 1532-429X
• DOI: 10.1186/s12968-017-0335-9

Left bundle branch block (LBBB) is common following trans-catheter aortic valve replacement (TAVR) and has been linked to increased mortality, although whether this is related to less favourable cardiac reverse remodeling is unclear. The aim of the study was to investigate the impact of TAVR induced LBBB on cardiac reverse remodeling. 48 patients undergoing TAVR for severe aortic stenosis were evaluated. 24 patients with new LBBB (LBBB-T) following TAVR were matched with 24 patients with a narrow post-procedure QRS (nQRS). Patients underwent cardiovascular magnetic resonance (CMR) prior to and 6 m post-TAVR. Measured cardiac reverse remodeling parameters included left ventricular (LV) size, ejection fraction (LVEF) and global longitudinal strain (GLS). Inter- and intra-ventricular dyssynchrony were determined using time to peak radial strain derived from CMR Feature Tracking. In the LBBB-T group there was an increase in QRS duration from 96 ± 14 to 151 ± 12 ms (P < 0.001) leading to inter- and intra-ventricular dyssynchrony (inter: LBBB-T 130 ± 73 vs nQRS 23 ± 86 ms, p < 0.001; intra: LBBB-T 118 ± 103 vs. nQRS 13 ± 106 ms, p = 0.001). Change in indexed LV end-systolic volume (LVESVi), LVEF and GLS was significantly different between the two groups (LVESVi: nQRS -7.9 ± 14.0 vs. LBBB-T -0.6 ± 10.2 ml/m , p = 0.02, LVEF: nQRS +4.6 ± 7.8 vs LBBB-T -2.1 ± 6.9%, p = 0.002; GLS: nQRS -2.1 ± 3.6 vs. LBBB-T +0.2 ± 3.2%, p = 0.024). There was a significant correlation between change in QRS and change in LVEF (r = -0.434, p = 0.002) and between change in QRS and change in GLS (r = 0.462, p = 0.001). Post-procedure QRS duration was an independent predictor of change in LVEF and GLS at 6 months. TAVR-induced LBBB is associated with less favourable cardiac reverse remodeling at medium term follow up. In view of this, every effort should be made to prevent TAVR-induced LBBB, especially as TAVR is now being extended to a younger, lower risk population.