No-invasive myocardial work for evaluation of global and segmental myocardial function in patients with left bundle branch block

doi:10.3877/cma.j.issn.1672-6448.2023.08.009

Abstract

Abstract:

Objective

To evaluate the global and segmental systolic function of the left ventricle in patients with left bundle branch block (LBBB) by noninvasive myocardial work (MW).

Methods

A total of 42 patients with true LBBB who received their first treatment at TEDA International Cardiovascular Hospital from September 2019 to May 2022 were divided into three groups according to left ventricular ejection fraction (LVEF): EF preserved group (LVEF≥50%), EF moderately reduced group (LVEF= 36%~49%), and EF severely reduced group (LVEF≤35%). Fifteen healthy people were selected as a control group. The following parameters were obtained and analyzed: global MW parameters including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), and segmental MW parameters including WI-septal, WI-lateral, CW-septal, CW-lateral, WW-septal, WW-lateral, WE-septal, and WE-lateral. The correlation between MW parameters and traditional parameters was analyzed.

Results

GWI and GWE were lower and GWW was higher in the LBBB groups than in the control group (P<0.05). CW-septal was lower than CW-lateral and WW-septal was higher than WW-lateral in the LBBB groups (P<0.05). Compared with the control group, WI-septal, CW-septal, and WE-septal decreased and WW-septal increased in both the EF preserved group and EF moderately reduced group (P<0.05), while only WW-lateral increased among the lateral segmental MW parameters (P<0.05). In the EF severely reduced group, WI-lateral and CW-lateral also decreased (P<0.05). Global and septal MW parameters showed a strong correlation with traditional parameters. Among global MW parameters, GWE showed the best correlation with LVEF, LVESV, and GLS (r=0.90, -0.80, and 0.95, respectively, P<0.001),while in segmental MW parameters,WE-septal showed the best correlation with LVEF, LVESV, and GLS (r=0.86, -0.76, and 0.86, respectively, P<0.01).

Conclusion

Myocardial work can be used to assess the global and segmental systolic function of the left ventricle in patients with LBBB in detail. When LVEF is not significantly reduced, septal function is impaired while lateral wall function is preserved. Lateral wall function is also impaired when LVEF is severely reduced.

Key words: Echocardiography, Left bundle branch block, Myocardial work

Jiaying Sun, Yunzhou Huang, Shutang Ren, Cuihua Wang, Xinhua Chen, Aijia Yu, Yuanlu Chen. No-invasive myocardial work for evaluation of global and segmental myocardial function in patients with left bundle branch block[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 836-843.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.08.009

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I08/836

Figures/Tables 6

References 19

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临床资料	对照组（n=15）	LBBB组			统计值	P值
临床资料	对照组（n=15）	EF保留组（n=17）	EF轻中度减低组（n=14）	EF重度减低组（n=11）	统计值	P值
年龄（岁）	60.14±8.16	67.53±9.95	64.71±7.29	60.73±10.64	F=2.231	0.101
男性[例（%）]	7（46.7）	8（47.1）	7（50.0）	7（63.6）	χ²=3.352	0.340
身高（cm）	162.50±8.65	162.50±8.70	163.14±7.88	169.27±7.47	F=1.854	0.145
体重（kg）	66.06±14.52	66.97±10.61	65.81±9.36	70.50±13.47	F=0.401	0.767
收缩压（mmHg）	127.71±13.62	138.63±13.88	143.71±22.45	125.09±17.68	F=2.738	0.052
舒张压（mmHg）	74.64±8.53	78.06±9.19	82.29±14.8	76.36±7.23	F=1.231	0.268
心率（次/分）	65.93±7.28	69.94±11.16	74.14±11.32	89.91±22.23^abc	F=6.909	<0.001
QRS时间（ms）	80.36±7.74	139.14±13.34^a	148.62±8.92^a	148.11±10.57^a	F=146.916	<0.001

临床资料	对照组（n=15）	LBBB组			统计值	P值
临床资料	对照组（n=15）	EF保留组（n=17）	EF轻中度减低组（n=14）	EF重度减低组（n=11）	统计值	P值
年龄（岁）	60.14±8.16	67.53±9.95	64.71±7.29	60.73±10.64	F=2.231	0.101
男性[例（%）]	7（46.7）	8（47.1）	7（50.0）	7（63.6）	χ²=3.352	0.340
身高（cm）	162.50±8.65	162.50±8.70	163.14±7.88	169.27±7.47	F=1.854	0.145
体重（kg）	66.06±14.52	66.97±10.61	65.81±9.36	70.50±13.47	F=0.401	0.767
收缩压（mmHg）	127.71±13.62	138.63±13.88	143.71±22.45	125.09±17.68	F=2.738	0.052
舒张压（mmHg）	74.64±8.53	78.06±9.19	82.29±14.8	76.36±7.23	F=1.231	0.268
心率（次/分）	65.93±7.28	69.94±11.16	74.14±11.32	89.91±22.23^abc	F=6.909	<0.001
QRS时间（ms）	80.36±7.74	139.14±13.34^a	148.62±8.92^a	148.11±10.57^a	F=146.916	<0.001

参数	对照组（n=15）	LBBB组			统计值	P值
参数	对照组（n=15）	EF保留组（n=17）	EF轻中度减低组（n=14）	EF重度减低组（n=11）	统计值	P值
LVEDV（ml，）	80.57±10.40	96.24±28.17	150.43±42.49^ab	247.91±89.65^abc	F=26.021	0.001
LVESV（ml，）	24.14±5.02	39.53±14.60	86.36±27.04^ab	182.18±73.71^abc	F=44.823	<0.001
LVEF（%，）	63.00±3.98	59.53±4.84	42.86±3.44^ab	27.45±6.06^abc	F=191.882	<0.001
SF[例（%）]	-	11（64.7）	13（92.9）	8（72.7）	χ²=4.675	0.322
心尖摆动[例（%）]	-	14（82.4）	11（78.6）	8（72.7）	χ²=0.404	0.817
典型LBBB曲线[例（%）]	-	10（58.8）	10（71.4）	8（72.7）	χ²=4.846	0.303
PSD（ms，）	36.64±8.59	78.76±24.25^a	120.43±48.20^ab	124.00±29.63^ab	F=17.405	<0.001
GLS（%，）	19.00±1.57	13.76±3.31^a	8.93±3.10^ab	5.27±2.53^abc	F=53.429	<0.001

参数	对照组（n=15）	LBBB组			统计值	P值
参数	对照组（n=15）	EF保留组（n=17）	EF轻中度减低组（n=14）	EF重度减低组（n=11）	统计值	P值
LVEDV（ml，）	80.57±10.40	96.24±28.17	150.43±42.49^ab	247.91±89.65^abc	F=26.021	0.001
LVESV（ml，）	24.14±5.02	39.53±14.60	86.36±27.04^ab	182.18±73.71^abc	F=44.823	<0.001
LVEF（%，）	63.00±3.98	59.53±4.84	42.86±3.44^ab	27.45±6.06^abc	F=191.882	<0.001
SF[例（%）]	-	11（64.7）	13（92.9）	8（72.7）	χ²=4.675	0.322
心尖摆动[例（%）]	-	14（82.4）	11（78.6）	8（72.7）	χ²=0.404	0.817
典型LBBB曲线[例（%）]	-	10（58.8）	10（71.4）	8（72.7）	χ²=4.846	0.303
PSD（ms，）	36.64±8.59	78.76±24.25^a	120.43±48.20^ab	124.00±29.63^ab	F=17.405	<0.001
GLS（%，）	19.00±1.57	13.76±3.31^a	8.93±3.10^ab	5.27±2.53^abc	F=53.429	<0.001

参数	对照组（n=15）	LBBB组			F值	P值
参数	对照组（n=15）	EF保留组（n=17）	EF轻中度减低组（n=14）	EF重度减低组（n=11）	F值	P值
GWI（mmHg%）	1912.79±314.18	1451.65±430.99^a	1012.57±395.97^ab	506.78±314.22^abc	29.335	<0.001
GCW（mmHg%）	2246.64±368.50	1975.71±433.77	1560.21±384.97^ab	933.44±341.17^abc	23.608	<0.001
GWW（mmHg%）	101.36±54.76	382.82±150.85^a	556.00±171.79^ab	447.00±110.09^a	29.229	<0.001
GWE（%）	95.00±1.92	83.18±6.40^a	71.64±7.97^ab	62.67±8.26^abc	56.275	<0.001
WI-septal（mmHg%）	1826.29±565.36	858.88±708.93^a	403.29±725.54^ab	-199.11±276.98^abc	22.031	<0.001
CW-septal（mmHg%）	2385.71±489.67	1648.82±498.33^a	1193.57±602.08^a	388.89±169.15^abc	32.937	<0.001
WW-septal（mmHg%）	78.57±65.26	805.88±522.58^a	1321.43±748.26^ab	858.89±289.29^ac	14.868	<0.001
WE-septal（%）	96.79±2.39	66.53±16.01^a	48.50±17.87^ab	30.22±19.67^abc	42.000	<0.001
WI-lateral（mmHg%）	1655.00±507.42	1618.65±515.32	1637.14±735.28	1273.78±486.22^abc	3.892	0.023
CW-lateral（mmHg%）	2085.71±363.44	2008.82±513.94	1971.43±725.02	1622.22±488.69^abc	2.897	0.036
WW-lateral（mmHg%）	60.71±48.43	238.24±138.17^a	248.57±207.99^a	127.44±121.99^bc	5.682	0.002
WE-lateral（%）	96.79±3.12	88.94±6.59	90.00±7.21	93.11±7.82	1.002	0.432

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