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Bertaglia, Emanuele (2016) Left Bundle Branch Block definition predicts response to cardiac resynchronization therapy. [Tesi di dottorato]

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Abstract (inglese)

Background. Cardiac resynchronization therapy (CRT) was proved to be effective in patients with heart failure and left bundle branch block (LBBB). Recently, new ECG criteria have been proposed for the diagnosis of LBBB. These criteria are stricter than the current American Heart Association (AHA) criteria and thus increase the specificity of LBBB diagnosis. We assessed the rate of echocardiographic response to CRT in patients who did and did not meet new criteria (Strict-LBBB).
Methods. Consecutive patients who received CRT defibrillators were enrolled in the CRT MORE registry. Patients with no-LBBB QRS morphology according to AHA, atrial fibrillation, right bundle branch block and right ventricular pacing were excluded from the analysis. Strict-LBBB was defined as: QRS ≥140ms for men and ≥130ms for women, QS or rS in V1–V2, mid-QRS notching or slurring in ≥2 contiguous leads. Patients showing a relative decrease of ≥15% in left ventricular end systolic volume (LVESV) at 12 months were defined as responders.
Results. Among 335 patients with AHA LBBB, 131 (39%) had Strict-LBBB. Patients with and without Strict-LBBB showed comparable baseline characteristics except for QRS duration (166±20ms vs 152±25ms, p<0.001). At 12-month evaluation responders were 205 (61%). 85 (65%) patients had Strict-LBBB and 120 (59%) had no Strict-LBBB (p=0.267). On multivariate analysis, history of atrial fibrillation, larger LVESV, and presence of mid-QRS notching in ≥1 lead (OR 1.96; 95%CI 1.04 to 3.70, p=0.038) were independently associated with the echocardiographic response.
Conclusions. Recently proposed stricter criteria for LBBB diagnosis did not improve the identification of CRT responders. Among ECG variables, only the presence of mid-QRS notching in at least 1 lead was associated with the echocardiographic response.

Abstract (italiano)

Introduzione. La terapia di re sincronizzazione cardiaca (RCT) si è dimostrata efficace nel trattamento dei pazienti con scompenso cardiaco e blocco di branca sinistro (BBSn). Recentemente sono stati proposti nuovi criteri ECG per definire il BBSn. Questi criteri sono più restrittivi rispetto a quelli utilizzati nella definizione dell’American Heart Association (AHA), incrementando la specificità della diagnosi di BBSn. In questo studio abbiamo determinato la risposta alla RCT in termini ecocardiografici in pazienti che rispettvano (Strict-LBBB) o no (Traditional-LBBB) la nuova definizione di BBSn.
Metodi. Abbiamo arruolato pazienti consecutivi sottoposti ad impianto di RCT (pacemaker o defibrillatore) inclusi nel Regustro CRT MORE. Sono stati esclusi dall’analisi pazienti che non rispettavano i criteri di BBSn secondo la definzione dell’AHA, fibrillazione atriale, blocco di branca destro e già portatori di pacemaker. Strict-LBBB è stato definito come: QRS ≥140ms per I maschi e ≥130ms per le femmine, QS o rS in V1–V2, mid-QRS notching o slurring in ≥2 derivazioni contigue. I pazienti che hanno dimostrato una riduzione relativa ≥15% del volume telesistiolico ventricolare sinistro (VTS) a 12 mesi sono stati definiti “responder”.
Risultati. Tra 335 pazienti con BBSn second la definizione LBBB, 131 (39%) presentavano Strict-LBBB. I pazienti com e senza Strict-LBBB presentavano caratteristiche cliniche ed elettrocardiografiche simili a parte la durata del QRS (166±20ms vs 152±25ms, p<0.001). Al controllo a 12 mesi sono risultati “responder” 205 (61%) pazienti: 85 (65%) pazienti con Strict-LBBB e 120 (59%) con Traditional-LBBB (p=0.267). All'analisi multivariata, la storia di fibrillazione atriale, il VTS più grande, e la presenza di mid-QRS notching in ≥1 derivazione (OR 1.96; 95%CI 1.04 to 3.70, p=0.038) sono risultati indipendentemente associati alla risposta ecocardiografica.
Conclusioni. La definizione più restrittiva di BBSn recentemente proposta non migliora l’identificazione dei pazienti responder” alla RCT rispetto alla definizone dell’AHA. Tra le variabili elettrocardiografiche, solo la presenza di mid-QRS notching in almeno una derivazione si correla alla risposta ecocardiografica alla CRT.

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Tipo di EPrint:Tesi di dottorato
Relatore:Basso, Cristina
Dottorato (corsi e scuole):Ciclo 28 > Scuole 28 > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > SCIENZE CARDIOVASCOLARI
Data di deposito della tesi:31 Gennaio 2016
Anno di Pubblicazione:31 Gennaio 2016
Parole chiave (italiano / inglese):Blocco di Branca Sinistro/Left Bundle Branch Block; terapia di resincronizzazione cardiaca/cardiac resynchronization therapy
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/11 Malattie dell'apparato cardiovascolare
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari
Codice ID:9494
Depositato il:21 Ott 2016 10:51
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