Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging
Background Considering that 30% to 40% of patients do not benefit from cardiac resynchronization therapy implantation, it is insufficient to evaluate patients with heart failure with reduced ejection fraction solely based on QRS duration and morphology for guiding cardiac resynchronization therapy d...
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2025-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040038 |
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| author | Di Zhou Mengdi Jiang Leyi Zhu Huaying Zhang Weichun Wu Jing Xu Wenjing Yang Yining Wang Xinqiao Lian Wenli Zhou Tingting Zheng Arlene Sirajuddin Andrew E. Arai Xiaohan Fan Shihua Zhao Minjie Lu |
| author_facet | Di Zhou Mengdi Jiang Leyi Zhu Huaying Zhang Weichun Wu Jing Xu Wenjing Yang Yining Wang Xinqiao Lian Wenli Zhou Tingting Zheng Arlene Sirajuddin Andrew E. Arai Xiaohan Fan Shihua Zhao Minjie Lu |
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| description | Background Considering that 30% to 40% of patients do not benefit from cardiac resynchronization therapy implantation, it is insufficient to evaluate patients with heart failure with reduced ejection fraction solely based on QRS duration and morphology for guiding cardiac resynchronization therapy decisions and prognosis. A crucial step in addressing this issue is conducting a comprehensive pathophysiological assessment to understand the mechanisms underlying dyssynchrony and inefficient cardiac contraction. This study aims to utilize cardiac magnetic resonance imaging to explore underlying pathophysiological impairments in patients with heart failure with reduced ejection fraction with different QRS morphologies, seeking to identify better indicators for clinical assessment. Methods A retrospective analysis was conducted on 887 consecutive patients with nonischemic heart failure with reduced ejection fraction and prolonged QRS duration who underwent cardiac magnetic resonance imaging, as well as 200 subjects with heart failure with reduced ejection fraction and normal QRS duration as the control group. Results Patients with left bundle‐branch block (LBBB) had a reduced left ventricular/right ventricular ejection fraction ratio compared with controls and patients with right bundle‐ branch block (RBBB) (LBBB versus RBBB versus controls: 0.6 [0.5, 0.8] versus 0.8 [0.6, 1.1] versus 0.8 [0.6, 1.1]). Late gadolinium enhancement percentage and extracellular volume fraction were significantly larger in patients with RBBB and nonspecific intraventricular conduction delay than in controls and patients with LBBB. Patients with LBBB or intraventricular conduction delay were associated with more impaired left ventricular torsion (LBBB versus intraventricular conduction delay versus RBBB: 0.3°/cm [−0.3, 0.5] versus 0.4°/cm [0.2, 0.7] versus 0.5°/cm [0.2, 0.8]) and strains than those with RBBB. Multivariable logistic regression revealed that the left ventricular/right ventricular ejection fraction ratio and torsion were independent determinants of LBBB. Conclusions A reduced left ventricular/right ventricular ejection fraction ratio and impaired left ventricular torsion may serve as valuable predictors of dyssynchrony, potentially identifying patients most likely to benefit from cardiac resynchronization therapy. |
| format | Article |
| id | doaj-art-23d86ccda48a49a4af4d6a9fee79945e |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-23d86ccda48a49a4af4d6a9fee79945e2025-08-20T03:07:50ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-05-01141010.1161/JAHA.124.040038Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance ImagingDi Zhou0Mengdi Jiang1Leyi Zhu2Huaying Zhang3Weichun Wu4Jing Xu5Wenjing Yang6Yining Wang7Xinqiao Lian8Wenli Zhou9Tingting Zheng10Arlene Sirajuddin11Andrew E. Arai12Xiaohan Fan13Shihua Zhao14Minjie Lu15Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Echocardiography, Fuwai Hospital and National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaNational Heart Lung and Blood Institute (NHLBI) Bethesda MD United StatesDivision of Cardiovascular Medicine and Department of Radiology University of Utah School of Medicine Salt Lake City UT United StatesDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaDepartment of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaBackground Considering that 30% to 40% of patients do not benefit from cardiac resynchronization therapy implantation, it is insufficient to evaluate patients with heart failure with reduced ejection fraction solely based on QRS duration and morphology for guiding cardiac resynchronization therapy decisions and prognosis. A crucial step in addressing this issue is conducting a comprehensive pathophysiological assessment to understand the mechanisms underlying dyssynchrony and inefficient cardiac contraction. This study aims to utilize cardiac magnetic resonance imaging to explore underlying pathophysiological impairments in patients with heart failure with reduced ejection fraction with different QRS morphologies, seeking to identify better indicators for clinical assessment. Methods A retrospective analysis was conducted on 887 consecutive patients with nonischemic heart failure with reduced ejection fraction and prolonged QRS duration who underwent cardiac magnetic resonance imaging, as well as 200 subjects with heart failure with reduced ejection fraction and normal QRS duration as the control group. Results Patients with left bundle‐branch block (LBBB) had a reduced left ventricular/right ventricular ejection fraction ratio compared with controls and patients with right bundle‐ branch block (RBBB) (LBBB versus RBBB versus controls: 0.6 [0.5, 0.8] versus 0.8 [0.6, 1.1] versus 0.8 [0.6, 1.1]). Late gadolinium enhancement percentage and extracellular volume fraction were significantly larger in patients with RBBB and nonspecific intraventricular conduction delay than in controls and patients with LBBB. Patients with LBBB or intraventricular conduction delay were associated with more impaired left ventricular torsion (LBBB versus intraventricular conduction delay versus RBBB: 0.3°/cm [−0.3, 0.5] versus 0.4°/cm [0.2, 0.7] versus 0.5°/cm [0.2, 0.8]) and strains than those with RBBB. Multivariable logistic regression revealed that the left ventricular/right ventricular ejection fraction ratio and torsion were independent determinants of LBBB. Conclusions A reduced left ventricular/right ventricular ejection fraction ratio and impaired left ventricular torsion may serve as valuable predictors of dyssynchrony, potentially identifying patients most likely to benefit from cardiac resynchronization therapy.https://www.ahajournals.org/doi/10.1161/JAHA.124.040038bundle‐branch blockcardiac magnetic resonanceheart failure with reduced ejection fractionnonspecific intraventricular conduction delayQRS morphology |
| spellingShingle | Di Zhou Mengdi Jiang Leyi Zhu Huaying Zhang Weichun Wu Jing Xu Wenjing Yang Yining Wang Xinqiao Lian Wenli Zhou Tingting Zheng Arlene Sirajuddin Andrew E. Arai Xiaohan Fan Shihua Zhao Minjie Lu Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease bundle‐branch block cardiac magnetic resonance heart failure with reduced ejection fraction nonspecific intraventricular conduction delay QRS morphology |
| title | Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging |
| title_full | Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging |
| title_fullStr | Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging |
| title_full_unstemmed | Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging |
| title_short | Towards Phenotyping Characteristics and Mechanism of Conduction Delay in Patients With Nonischemic Heart Failure With Reduced Ejection Fraction: Insights From Cardiac Magnetic Resonance Imaging |
| title_sort | towards phenotyping characteristics and mechanism of conduction delay in patients with nonischemic heart failure with reduced ejection fraction insights from cardiac magnetic resonance imaging |
| topic | bundle‐branch block cardiac magnetic resonance heart failure with reduced ejection fraction nonspecific intraventricular conduction delay QRS morphology |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040038 |
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