Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation
We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at base...
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| Veröffentlicht in: | Journal of applied physiology (1985) 2020-04, Vol.128 (4), p.729-738 |
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| creator | Andersen, Øyvind S Krogh, Magnus R Boe, Espen Storsten, Petter Aalen, John M Larsen, Camilla K Skulstad, Helge Odland, Hans H Smiseth, Otto A Remme, Espen W |
| description | We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at baseline heart rate (120 beats/min) and atrial paced tachycardia (180 beats/min) before and after induction of LBBB and during CRT. LV and left atrial pressures (LAP) were measured by micromanometers and dimensions by sonomicrometry. The time constant τ of exponential pressure decay and degree of incomplete relaxation at mitral valve opening (MVO) and end diastole (ED) based on extrapolation of the exponential decay were assessed. Changes in LV diastolic distensibility were investigated using the LV transmural pressure-volume (PV) relation. LBBB caused prolongation of τ (
< 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO (
< 0.001) and ED (
= 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all
< 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures (
< 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent.
Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting. |
| doi_str_mv | 10.1152/japplphysiol.01002.2018 |
| format | Article |
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< 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO (
< 0.001) and ED (
= 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all
< 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures (
< 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent.
Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting.</description><identifier>ISSN: 8750-7587</identifier><identifier>EISSN: 1522-1601</identifier><identifier>DOI: 10.1152/japplphysiol.01002.2018</identifier><identifier>PMID: 31999529</identifier><language>eng</language><publisher>United States: American Physiological Society</publisher><subject>Blood pressure ; Cardiac arrhythmia ; Decay ; Diastole ; Diastolic pressure ; Dyspnea ; Electrocardiography ; Heart rate ; Heart valves ; Intolerance ; Mitral valve ; Prolongation ; Respiration ; Tachycardia ; Time constant ; Ventricle</subject><ispartof>Journal of applied physiology (1985), 2020-04, Vol.128 (4), p.729-738</ispartof><rights>Copyright American Physiological Society Apr 2020</rights><rights>info:eu-repo/semantics/openAccess</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c480t-bbffd4f959a3aef8a8577037578e5d5dab0309cb55a97260f2a0bdd9172b838d3</citedby><cites>FETCH-LOGICAL-c480t-bbffd4f959a3aef8a8577037578e5d5dab0309cb55a97260f2a0bdd9172b838d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,3026,26544,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31999529$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Andersen, Øyvind S</creatorcontrib><creatorcontrib>Krogh, Magnus R</creatorcontrib><creatorcontrib>Boe, Espen</creatorcontrib><creatorcontrib>Storsten, Petter</creatorcontrib><creatorcontrib>Aalen, John M</creatorcontrib><creatorcontrib>Larsen, Camilla K</creatorcontrib><creatorcontrib>Skulstad, Helge</creatorcontrib><creatorcontrib>Odland, Hans H</creatorcontrib><creatorcontrib>Smiseth, Otto A</creatorcontrib><creatorcontrib>Remme, Espen W</creatorcontrib><title>Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation</title><title>Journal of applied physiology (1985)</title><addtitle>J Appl Physiol (1985)</addtitle><description>We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at baseline heart rate (120 beats/min) and atrial paced tachycardia (180 beats/min) before and after induction of LBBB and during CRT. LV and left atrial pressures (LAP) were measured by micromanometers and dimensions by sonomicrometry. The time constant τ of exponential pressure decay and degree of incomplete relaxation at mitral valve opening (MVO) and end diastole (ED) based on extrapolation of the exponential decay were assessed. Changes in LV diastolic distensibility were investigated using the LV transmural pressure-volume (PV) relation. LBBB caused prolongation of τ (
< 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO (
< 0.001) and ED (
= 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all
< 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures (
< 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent.
Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting.</description><subject>Blood pressure</subject><subject>Cardiac arrhythmia</subject><subject>Decay</subject><subject>Diastole</subject><subject>Diastolic pressure</subject><subject>Dyspnea</subject><subject>Electrocardiography</subject><subject>Heart rate</subject><subject>Heart valves</subject><subject>Intolerance</subject><subject>Mitral valve</subject><subject>Prolongation</subject><subject>Respiration</subject><subject>Tachycardia</subject><subject>Time constant</subject><subject>Ventricle</subject><issn>8750-7587</issn><issn>1522-1601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>3HK</sourceid><recordid>eNpdkU1vVCEUQImxsWPbv2BJ3Lh50wtvKLA0Tf1IJnGja8LXcxgZeAKvcf69jG2NcUUC555LchC6JrAmhNGbvZ7nOO-ONeS4BgJA1xSIeIFW_ZUO5BbIS7QSnMHAmeDn6HWtewCy2TDyCp2PRErJqFyhh62fGjZLctFjU3SyO2xitj9wSLZ4XX3F8YQ8-NRKsEvUBbuga8sxWDwXX-tSPHZLCek7btrujlaXTvQrj1s-efJhjr55XHzUv3QLOV2is0nH6q-ezgv07cP917tPw_bLx89377eD3QhogzHT5DaTZFKP2k9CC8Y5jJxx4ZljThsYQVrDmJac3sJENRjnJOHUiFG48QJdP3ptCbWFpFIuWhEQjCrRPdCJd4_EXPLPxdemDqFaH6NOPi9V0ZEBSM7Z2NG3_6H7vJTU_98pCYR1oegUf16Zay1-UnMJB12Ofa06xVP_xlN_4qlTvD755sm_mIN3f-eea42_AYNtmpI</recordid><startdate>20200401</startdate><enddate>20200401</enddate><creator>Andersen, Øyvind S</creator><creator>Krogh, Magnus R</creator><creator>Boe, Espen</creator><creator>Storsten, Petter</creator><creator>Aalen, John M</creator><creator>Larsen, Camilla K</creator><creator>Skulstad, Helge</creator><creator>Odland, Hans H</creator><creator>Smiseth, Otto A</creator><creator>Remme, Espen W</creator><general>American Physiological Society</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope><scope>3HK</scope></search><sort><creationdate>20200401</creationdate><title>Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation</title><author>Andersen, Øyvind S ; Krogh, Magnus R ; Boe, Espen ; Storsten, Petter ; Aalen, John M ; Larsen, Camilla K ; Skulstad, Helge ; Odland, Hans H ; Smiseth, Otto A ; Remme, Espen W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c480t-bbffd4f959a3aef8a8577037578e5d5dab0309cb55a97260f2a0bdd9172b838d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Blood pressure</topic><topic>Cardiac arrhythmia</topic><topic>Decay</topic><topic>Diastole</topic><topic>Diastolic pressure</topic><topic>Dyspnea</topic><topic>Electrocardiography</topic><topic>Heart rate</topic><topic>Heart valves</topic><topic>Intolerance</topic><topic>Mitral valve</topic><topic>Prolongation</topic><topic>Respiration</topic><topic>Tachycardia</topic><topic>Time constant</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Andersen, Øyvind S</creatorcontrib><creatorcontrib>Krogh, Magnus R</creatorcontrib><creatorcontrib>Boe, Espen</creatorcontrib><creatorcontrib>Storsten, Petter</creatorcontrib><creatorcontrib>Aalen, John M</creatorcontrib><creatorcontrib>Larsen, Camilla K</creatorcontrib><creatorcontrib>Skulstad, Helge</creatorcontrib><creatorcontrib>Odland, Hans H</creatorcontrib><creatorcontrib>Smiseth, Otto A</creatorcontrib><creatorcontrib>Remme, Espen W</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><jtitle>Journal of applied physiology (1985)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Andersen, Øyvind S</au><au>Krogh, Magnus R</au><au>Boe, Espen</au><au>Storsten, Petter</au><au>Aalen, John M</au><au>Larsen, Camilla K</au><au>Skulstad, Helge</au><au>Odland, Hans H</au><au>Smiseth, Otto A</au><au>Remme, Espen W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation</atitle><jtitle>Journal of applied physiology (1985)</jtitle><addtitle>J Appl Physiol (1985)</addtitle><date>2020-04-01</date><risdate>2020</risdate><volume>128</volume><issue>4</issue><spage>729</spage><epage>738</epage><pages>729-738</pages><issn>8750-7587</issn><eissn>1522-1601</eissn><abstract>We investigated whether tachycardia in left bundle branch block (LBBB) decreases left ventricular (LV) diastolic distensibility and increases diastolic pressures due to incomplete relaxation, and if cardiac resynchronization therapy (CRT) modifies this response. Thirteen canines were studied at baseline heart rate (120 beats/min) and atrial paced tachycardia (180 beats/min) before and after induction of LBBB and during CRT. LV and left atrial pressures (LAP) were measured by micromanometers and dimensions by sonomicrometry. The time constant τ of exponential pressure decay and degree of incomplete relaxation at mitral valve opening (MVO) and end diastole (ED) based on extrapolation of the exponential decay were assessed. Changes in LV diastolic distensibility were investigated using the LV transmural pressure-volume (PV) relation. LBBB caused prolongation of τ (
< 0.03) and increased the degree of incomplete relaxation during tachycardia at MVO (
< 0.001) and ED (
= 0.08) compared with normal electrical activation. This was associated with decreased diastolic distensibility seen as upward shift of the PV relation at MVO by 18.4 ± 7.0 versus 12.0 ± 5.0 mmHg, at ED by 9.8 ± 2.3 versus 4.7 ± 2.3 mmHg, and increased mean LAP to 11.4 ± 2.7 versus 8.5 ± 2.6 mmHg, all
< 0.006. CRT shifted the LV diastolic PV relation downwards during tachycardia, reducing LAP and LV diastolic pressures (
< 0.03). Tachycardia in LBBB reduced LV diastolic distensibility and increased LV diastolic pressures due to incomplete relaxation, whereas CRT normalized these effects. Clinical studies are needed to determine whether a similar mechanism contributes to dyspnea and exercise intolerance in LBBB and if effects of CRT are heart rate dependent.
Compared with normal electrical conduction, tachycardia in left bundle branch block resulted in incomplete relaxation during filling, particularly of the late activated left ventricular lateral wall. This further resulted in reduced left ventricular diastolic distensibility and elevated diastolic pressures and thus amplified the benefits of cardiac resynchronization therapy in this setting.</abstract><cop>United States</cop><pub>American Physiological Society</pub><pmid>31999529</pmid><doi>10.1152/japplphysiol.01002.2018</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| source | NORA - Norwegian Open Research Archives; American Physiological Society; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Blood pressure Cardiac arrhythmia Decay Diastole Diastolic pressure Dyspnea Electrocardiography Heart rate Heart valves Intolerance Mitral valve Prolongation Respiration Tachycardia Time constant Ventricle |
| title | Left bundle branch block increases left ventricular diastolic pressure during tachycardia due to incomplete relaxation |
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