Correlation between electrocardiographic features and mechanical dyssynchrony in heart failure patients with left bundle branch block.
BACKGROUND
Few electrocardiographic parameters beyond the QRS duration were studied with regard to the correlation with mechanical dyssynchrony. This study aims to analyze the correlation between electrocardiographic parameters and mechanical dyssynchrony in patients with symptomatic heart failure (HF) and left bundle branch block (LBBB).


METHODS
Patients with HF, ejection fraction ≤ 35%, and QRS interval ≥ 120 ms with a LBBB were prospectively studied. We analyzed the correlation between electrocardiographic parameters (QRS duration, R voltage in limb leads, S voltage in precordial leads, Sokolow and Cornell indexes, QRS axis deviation, and QRS notches in lateral and inferior leads) and mechanical dyssynchrony measured by tissue Doppler imaging (TDI).


RESULTS
A group of 50 patients were studied, 60% male, 78% with nonischemic cardiomyopathy, NYHA Class III-IV (86%), and ejection fraction of 0.22 ± 0.6. Intra- and interventricular dyssynchrony occurred in 68% and 74% of patients, respectively. The S amplitude in precordial leads and the Sokolow and Cornel indexes show a weak correlation with the degree of dyssynchrony. In the patients with QRS notching in the lateral and inferior leads, we observed significantly greater prevalence of intraventricular dyssynchrony, with sensitivity and specificity of 85% and 56%, respectively, for notches in lateral leads. The QRS duration presents moderate correlation with the degree of both intraventricular (r = 0.48) and interventricular dyssynchrony (r = 0.46).


CONCLUSIONS
The following electrocardiographic parameters were related to the degree of mechanical dyssynchrony: QRS duration and notches in QRS. In addition, the patients tend to have highest S amplitude in precordial leads.
Division of Cardiology, Onofre Lopes University Hospital-Faculty of Medicine, Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha 620, Petrópolis, Natal, Brazil.
Nestor Rodrigues de Oliveira
NR
Neto
George Cobe
GC
Fonseca
Gustavo Gomes
GG
Torres
Marcos Antonio
MA
Pinheiro
George Barreto
GB
Miranda
D000368:Aged; D002037:Bundle-Branch Block / Q000453:epidemiology* / Q000503:physiopathology; D054459:Elasticity Imaging Techniques; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
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