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. 2022 Oct 20:9:977414.
doi: 10.3389/fcvm.2022.977414. eCollection 2022.

Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Antonia Petersen  1 , Sebastian Niko Nagel  1 , Bernd Hamm  1 , Thomas Elgeti  1 , Lars-Arne Schaafs  1
Affiliations

Cardiac magnetic resonance imaging in patients with left bundle branch block: Patterns of dyssynchrony and implications for late gadolinium enhancement imaging

Antonia Petersen et al. Front Cardiovasc Med. .

Abstract

Background: Left bundle branch block (LBBB) is a ventricular conduction delay with high prevalence. Aim of our study is to identify possible recurring patterns of artefacts in late gadolinium enhancement (LGE) imaging in patients with LBBB who undergo cardiac magnetic resonance imaging (MRI) and to define parameters of mechanical dyssynchrony associated with artefacts in LGE images.

Materials and methods: Fifty-five patients with LBBB and 62 controls were retrospectively included. Inversion time (TI) scout and LGE images were reviewed for artefacts. Dyssynchrony was identified using cardiac MRI by determining left ventricular systolic dyssynchrony indices (global, septal segments, and free wall segments) derived from strain analysis and features of mechanical dyssynchrony (apical rocking and septal flash).

Results: Thirty-seven patients (67%) with LBBB exhibited inhomogeneous myocardial nulling in TI scout images. Among them 25 (68%) patients also showed recurring artefact patterns in the septum or free wall on LGE images and artefacts also persisted in 18 (72%) of those cases when utilising phase sensitive inversion recovery. Only the systolic dyssynchrony index of septal segments allowed differentiation of patient subgroups (artefact/no artefact) and healthy controls (given as median, median ± interquartile range); LBBB with artefact: 10.44% (0.44-20.44%); LBBB without artefact: 6.82% (-2.18-15.83%); controls: 4.38% (1.38-7.38%); p < 0.05 with an area under the curve of 0.863 (81% sensitivity, 89% specificity). Septal flash and apical rocking were more frequent in the LBBB with artefact group than in the LBBB without artefact group (70 and 62% versus 33 and 17%; p < 0.05).

Conclusion: Patients with LBBB show recurring artefact patterns in LGE imaging. Use of strain analysis and evaluation of mechanical dyssynchrony may predict the occurrence of such artefacts already during the examination and counteract misinterpretation.

Keywords: artefacts; cardiac MRI; late gadolinium enhancement (LGE); left bundle branch block (LBBB); strain analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Findings on TI scout images. Artefact-free TI scout (A) in a healthy control. Images (B,C) show different degrees of inhomogeneous myocardial nulling in patients with LBBB, resulting in a pronounced, C-shaped nulling of the septal and anterior wall segments. Review of supplemental sequences revealed no morphologic correlate in any of the cases shown.
FIGURE 2
FIGURE 2
Findings on LGE images. Artefact-free images of a healthy control (A). Columns (B,C) show examples of artefacts in patients with LBBB each resulting in an amorphous signal increase within the myocardium (white arrow heads) without a correlate in an intersecting plane. Examples of true LGE (white arrows) in patients with LBBB are shown in columns (D,E). Here, both planes show an intramyocardial (septum) and subendocardial (free wall) signal increase (D) respectively a typical subepicardial signal increase (E). The red dashed lines depict the respective intersection of both planes shown.
FIGURE 3
FIGURE 3
Comparison of systolic dyssynchrony indices. Comparison of SDIglobal, SDIseptal, and SDIfree wall between all three subgroups. An asterisk (*) indicates a statistically significant difference (p < 0.05).
See this image and copyright information in PMC

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