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The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy

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Emerek, Kasper ; Friedman, Daniel J ; Sørensen, Peter L ; Hansen, Steen M ; Larsen, Jacob M ; Risum, Niels ; Thøgersen, Anna Margrethe ; Graff, Claus ; Atwater, Brett D ; Kisslo, Joseph ; Søgaard, Peter. / The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy. I: Cardiovascular Ultrasound. 2019 ; Bind 17, Nr. 1. s. 10.

Bibtex

@article{ab4d26e1755247fe8369709a6d8dc880,
title = "The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy",
abstract = "BACKGROUND: The association of a Classical left bundle branch block (LBBB) contraction pattern and better outcome after cardiac resynchronization therapy (CRT) has only been studied using vendor-specific software for echocardiographic speckle-tracked longitudinal strain analysis. The purpose of this study was to assess whether a Classical LBBB contraction pattern on longitudinal strain analysis using vendor-independent software is associated with clinical outcome in CRT recipients with LBBB.METHODS: This was a retrospective cohort study including CRT recipients with LBBB, heart failure, and left ventricular (LV) ejection fraction ≤35{\%}. Speckle-tracked echocardiographic longitudinal strain analysis was performed retrospectively on echocardiograms using vendor-independent software. The presence of a Classical LBBB contraction pattern was determined by consensus of two readers. The primary end point was a composite of time to death, heart transplantation or LV assist device implantation. Secondary outcome was ≥15{\%} reduction in LV end-systolic volume. Intra- and inter-reader agreement of the longitudinal strain contraction pattern was assessed by calculating Cohen's κ.RESULTS: Of 283 included patients, 113 (40{\%}) were women, mean age was 66 ± 11 years, and 136 (48{\%}) had ischemic heart disease. A Classical LBBB contraction pattern was present in 196 (69{\%}). The unadjusted hazard ratio for reaching the primary end point was 1.93 (95{\%} confidence interval, 1.36-2.76, p < 0.001) when comparing patients without to patients with a Classical LBBB contraction pattern. Adjusted for ischemic heart disease and QRS duration < 150 milliseconds the hazard ratio was 1.65 (95{\%} confidence interval, 1.12-2.43, p = 0.01). Of the 123 (43{\%}) patients with a follow-up echocardiogram, 64 of 85 (75{\%}) of patients with a Classical LBBB contraction pattern compared to 13 of 38 (34{\%}) without, had ≥15{\%} reduction in LV end-systolic volume (p < 0.001). Cohen's κ were 0.86 (95{\%} confidence interval, 0.71-1.00) and 0.42 (95{\%} confidence interval, 0.30-0.54) for intra- and inter-reader agreement, respectively.CONCLUSION: Using vendor-independent strain software, a Classical LBBB contraction pattern is associated with better outcome in CRT recipients with LBBB, but inter-reader agreement for the classification of contraction pattern is only moderate.",
keywords = "Aged, Bundle-Branch Block/diagnosis, Cardiac Resynchronization Therapy/methods, Commerce, Echocardiography/methods, Electrocardiography, Female, Follow-Up Studies, Heart Ventricles/diagnostic imaging, Humans, Image Interpretation, Computer-Assisted, Male, Myocardial Contraction/physiology, Retrospective Studies, Software, Stroke Volume/physiology, Ventricular Function, Left/physiology",
author = "Kasper Emerek and Friedman, {Daniel J} and S{\o}rensen, {Peter L} and Hansen, {Steen M} and Larsen, {Jacob M} and Niels Risum and Th{\o}gersen, {Anna Margrethe} and Claus Graff and Atwater, {Brett D} and Joseph Kisslo and Peter S{\o}gaard",
year = "2019",
month = "5",
day = "21",
doi = "10.1186/s12947-019-0160-4",
language = "English",
volume = "17",
pages = "10",
journal = "Cardiovascular Ultrasound",
issn = "1476-7120",
publisher = "BioMed Central Ltd",
number = "1",

}

RIS

TY - JOUR

T1 - The Association of a classical left bundle Branch Block Contraction Pattern by vendor-independent strain echocardiography and outcome after cardiac resynchronization therapy

AU - Emerek, Kasper

AU - Friedman, Daniel J

AU - Sørensen, Peter L

AU - Hansen, Steen M

AU - Larsen, Jacob M

AU - Risum, Niels

AU - Thøgersen, Anna Margrethe

AU - Graff, Claus

AU - Atwater, Brett D

AU - Kisslo, Joseph

AU - Søgaard, Peter

PY - 2019/5/21

Y1 - 2019/5/21

N2 - BACKGROUND: The association of a Classical left bundle branch block (LBBB) contraction pattern and better outcome after cardiac resynchronization therapy (CRT) has only been studied using vendor-specific software for echocardiographic speckle-tracked longitudinal strain analysis. The purpose of this study was to assess whether a Classical LBBB contraction pattern on longitudinal strain analysis using vendor-independent software is associated with clinical outcome in CRT recipients with LBBB.METHODS: This was a retrospective cohort study including CRT recipients with LBBB, heart failure, and left ventricular (LV) ejection fraction ≤35%. Speckle-tracked echocardiographic longitudinal strain analysis was performed retrospectively on echocardiograms using vendor-independent software. The presence of a Classical LBBB contraction pattern was determined by consensus of two readers. The primary end point was a composite of time to death, heart transplantation or LV assist device implantation. Secondary outcome was ≥15% reduction in LV end-systolic volume. Intra- and inter-reader agreement of the longitudinal strain contraction pattern was assessed by calculating Cohen's κ.RESULTS: Of 283 included patients, 113 (40%) were women, mean age was 66 ± 11 years, and 136 (48%) had ischemic heart disease. A Classical LBBB contraction pattern was present in 196 (69%). The unadjusted hazard ratio for reaching the primary end point was 1.93 (95% confidence interval, 1.36-2.76, p < 0.001) when comparing patients without to patients with a Classical LBBB contraction pattern. Adjusted for ischemic heart disease and QRS duration < 150 milliseconds the hazard ratio was 1.65 (95% confidence interval, 1.12-2.43, p = 0.01). Of the 123 (43%) patients with a follow-up echocardiogram, 64 of 85 (75%) of patients with a Classical LBBB contraction pattern compared to 13 of 38 (34%) without, had ≥15% reduction in LV end-systolic volume (p < 0.001). Cohen's κ were 0.86 (95% confidence interval, 0.71-1.00) and 0.42 (95% confidence interval, 0.30-0.54) for intra- and inter-reader agreement, respectively.CONCLUSION: Using vendor-independent strain software, a Classical LBBB contraction pattern is associated with better outcome in CRT recipients with LBBB, but inter-reader agreement for the classification of contraction pattern is only moderate.

AB - BACKGROUND: The association of a Classical left bundle branch block (LBBB) contraction pattern and better outcome after cardiac resynchronization therapy (CRT) has only been studied using vendor-specific software for echocardiographic speckle-tracked longitudinal strain analysis. The purpose of this study was to assess whether a Classical LBBB contraction pattern on longitudinal strain analysis using vendor-independent software is associated with clinical outcome in CRT recipients with LBBB.METHODS: This was a retrospective cohort study including CRT recipients with LBBB, heart failure, and left ventricular (LV) ejection fraction ≤35%. Speckle-tracked echocardiographic longitudinal strain analysis was performed retrospectively on echocardiograms using vendor-independent software. The presence of a Classical LBBB contraction pattern was determined by consensus of two readers. The primary end point was a composite of time to death, heart transplantation or LV assist device implantation. Secondary outcome was ≥15% reduction in LV end-systolic volume. Intra- and inter-reader agreement of the longitudinal strain contraction pattern was assessed by calculating Cohen's κ.RESULTS: Of 283 included patients, 113 (40%) were women, mean age was 66 ± 11 years, and 136 (48%) had ischemic heart disease. A Classical LBBB contraction pattern was present in 196 (69%). The unadjusted hazard ratio for reaching the primary end point was 1.93 (95% confidence interval, 1.36-2.76, p < 0.001) when comparing patients without to patients with a Classical LBBB contraction pattern. Adjusted for ischemic heart disease and QRS duration < 150 milliseconds the hazard ratio was 1.65 (95% confidence interval, 1.12-2.43, p = 0.01). Of the 123 (43%) patients with a follow-up echocardiogram, 64 of 85 (75%) of patients with a Classical LBBB contraction pattern compared to 13 of 38 (34%) without, had ≥15% reduction in LV end-systolic volume (p < 0.001). Cohen's κ were 0.86 (95% confidence interval, 0.71-1.00) and 0.42 (95% confidence interval, 0.30-0.54) for intra- and inter-reader agreement, respectively.CONCLUSION: Using vendor-independent strain software, a Classical LBBB contraction pattern is associated with better outcome in CRT recipients with LBBB, but inter-reader agreement for the classification of contraction pattern is only moderate.

KW - Aged

KW - Bundle-Branch Block/diagnosis

KW - Cardiac Resynchronization Therapy/methods

KW - Commerce

KW - Echocardiography/methods

KW - Electrocardiography

KW - Female

KW - Follow-Up Studies

KW - Heart Ventricles/diagnostic imaging

KW - Humans

KW - Image Interpretation, Computer-Assisted

KW - Male

KW - Myocardial Contraction/physiology

KW - Retrospective Studies

KW - Software

KW - Stroke Volume/physiology

KW - Ventricular Function, Left/physiology

U2 - 10.1186/s12947-019-0160-4

DO - 10.1186/s12947-019-0160-4

M3 - Journal article

VL - 17

SP - 10

JO - Cardiovascular Ultrasound

JF - Cardiovascular Ultrasound

SN - 1476-7120

IS - 1

ER -

ID: 59170072