Circulation, Vol 79, 845-853, Copyright © 1989 by American Heart Association
CL Grines, TM Bashore, H Boudoulas, S Olson, P Shafer and CF Wooley
Eighteen patients with isolated left bundle branch block (LBBB) were
compared with 10 normal control subjects. Apexcardiograms,
phonocardiograms, electrocardiograms, two-dimensional and dual M-mode
echocardiograms, and radionuclide ventriculograms (RNV) were performed.
There were no differences in the timing of right ventricular events between
LBBB and normal subjects; however, striking delays in left ventricular
systolic and diastolic events were apparent in the LBBB group. The delay
was associated with shortening of left ventricular diastole and resultant
increase in the ratio of right to left ventricular diastolic time in LBBB
(1.2 +/- 0.08) compared with normal (1.0 +/- 0.06), p less than 0.0001.
First heart sound (S1) amplitude, expressed as the ratio S1/S2, was
decreased in LBBB compared with normal (0.67 +/- 0.2 compared with 1.34 +/-
0.25, p less than 0.01), in part due to wide separation of the valvular
contributors to S1. The abnormal interventricular septal motion in LBBB
corresponded to periods of asynchrony in contraction, ejection, end
systole, and end diastole between right and left ventricles. Radionuclide
ventriculograms revealed decreased regional ejection fraction of the septum
in LBBB (40 +/- 16%) compared with 67 +/- 7% in normal subjects (p less
than 0.001), while the apical and lateral regional ejection fractions were
similar in the two groups. This loss of septal contribution resulted in a
reduction in global ejection fraction in LBBB compared to normals (54 +/-
7% compared with 62 +/- 5%, p less than 0.005).(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony
Department of Internal Medicine, Ohio State University, Columbus.
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