Heart Failure with Preserved Ejection Fraction–Association of Diastolic Dysfunction and Left Bundle Branch Block

Left bundle branch block (LBBB) causes dysynchronous contraction of the left ventricle and can identify patients with heart failure (HF) reduced ejection fraction (HFREF) who benefit from cardiac re-synchronisation therapy. HF preserved ejection fraction (HFPEF) is a distinct syndrome with nebulous management guidelines. We investigated the association of HF, LBBB and diastolic dysfunction. We utilised a prospectively collected database enrolling all patients seen in a tertiary hospital HF clinic from 2004 - 2015. Inclusion criteria: HF clinic attendance, echocardiogram with diastolic function comment and contemporary 12-lead ECG. Diastolic function was assessed qualitatively by a consultant cardiologist. ECGs were independently assessed by consultant electrophysiologists. Patients were grouped per ejection fraction (EF). HFPEF as EF ≥50%, HFMEF as 40-49% and HFREF as <40%. Table 1.Table 1Diastolic dysfunction subdivided by EF and LBBB in patients with HF.HFPEFHFMEFHFREFLBBBNo LBBBLBBBNo LBBBLBBBNo LBBBN58415373138Nil or Grade 1Diastolic Dysfunction (%)034.520.027.016.115.8Grade 2 or 3Diastolic Dysfunction (%)10065.580.073.083.984.2Diastolic function may be worse in HFPEF patients who also have LBBB. No such association was found for HFMEF or HFREF. Most patients with HFREF also have concomitant diastolic dysfunction and their management should reflect this. Open table in a new tab Diastolic function may be worse in HFPEF patients who also have LBBB. No such association was found for HFMEF or HFREF. Most patients with HFREF also have concomitant diastolic dysfunction and their management should reflect this.