Key result
In patients with HFrEF, left bundle branch block was associated with similar rates of left ventricular recovery compared to those without LBBB (27.8% vs. 31.5%, P=0.47).
Why the study?
Distinctive CMR features in non-ischaemic HFrEF patients with LBBB, and predictors of LVEF recovery compared to those without LBBB, remained to be identified.
Do patients with HFrEF and LBBB exhibit distinctive CMR features and different rates of LV recovery compared to those without LBBB?
Cohort (n=391)
Do patients with HFrEF and LBBB exhibit distinctive CMR features and different rates of LV recovery compared to those without LBBB?
Absolute Event Rate: 27.8% vs 31.5%
p-value: p=0.47
Patients with HFrEF and LBBB have similar rates of early LV recovery compared to those without LBBB, supporting current guidelines to defer device therapy until 3-6 months of guideline-directed medical therapy.
Aims We aimed to identify the distinctive cardiovascular magnetic resonance (CMR) features of patients with left bundle branch block (LBBB) and heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology. The secondary aim was to determine whether these individuals exhibit characteristics that could potentially serve as predictors of left ventricular ejection fraction (LVEF) recovery as compared with patients without LBBB. Methods and results We prospectively recruited patients with HFrEF (LVEF ≤ 40%) on echocardiography who were referred for early CMR examination. Patients with an established diagnosis of coronary artery disease and known structural or congenital heart disease were excluded. LV recovery was defined as achieving ≥10% absolute improvement to ≥40% in LVEF between baseline evaluation to CMR. A total of 391 patients were recruited including 115 (29.4%) with LBBB. Compared with HF patients without LBBB, those with LBBB exhibited larger left ventricles and smaller right ventricles, but no differences were observed with respect to LVEF (35.8 ± 12 vs. 38 ± 12%, P = 0.105). The overall rate of LV recovery from baseline echocardiogram to CMR (70 [42–128] days) was not significantly different between LBBB and non-LBBB patients (27.8% vs. 31.5%, P = 0.47). Reduced LVEF remained an independent predictor of LV non-recovery only in patients with LBBB. Conclusion Patients presenting with HFrEF and LBBB had larger LV cavities and smaller RV cavities than those without LBBB but no difference in prevalence of scar or ischaemia. The rates of LV recovery were similar between both groups, which supports current guidelines to defer device therapy until 3–6 months of guideline-directed medical therapy, rather than early CMR and device implantation.
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Tomoaia et al. (2024) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) of presumed non-ischaemic aetiology (n=391). Left bundle branch block (LBBB) vs. Patients without LBBB was evaluated on LV recovery (achieving ≥10% absolute improvement to ≥40% in LVEF between baseline evaluation to CMR) (p=0.47). In patients with HFrEF, left bundle branch block was associated with similar rates of left ventricular recovery compared to those without LBBB (27.8% vs. 31.5%, P=0.47).
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