Inflammation and myocardial fibrosis: is there a relation with left bundle branch block

Cover Page

Cite item

Full Text

Abstract

Aim. To assess myocardial changes during left bundle branch block (LBBB) in patients with dilated cardiomyopathy (DCM) and in structurally normal hearts.

Materials and methods. Seventy three patients with clinic-instrumental signs of DCM, were divided into 2 groups with LBBB (group 1; n=41) and without LBBB (group 2; n=32). Moreover, 15 patients with LBBB with no signs of structural heart diseases (group 3) and 10 healthy subjects were included in the study. Fibrosis assessment and the inflammation detection was performed by cardiovascular magnetic resonance (CMR). The inflammation in 15 patients from group 1 and 16 patients from group 2 was confirmed by endomyocardial biopsy (EMB). Moreover, the level of transforming growing factor β1was assessed in serum of all patients and healthy subjects (TGF-β1).

Results. The diffuse inflammatory process was defined in 46.7% cases of group 1 according to EMB data. The frequency of inflammation detection in groups 1 and 2 was comparable in EMB analyses (p=0,64) and CMR analyses (12,2% positive cases in group 1 vs 50% in group 2; p=0,18). The frequency of focal left ventricular fibrosis and intramural scar in the interventricular septum (“stria”) was also comparable in groups 1 and 2: 16 (39%) positive cases with focal fibrosis in group 1 versus 17 (53%) cases in group 2; p=0,35 and 6 (14,6%) cases with intramural scar in group 1 versus 7 (22%) in group 2; p=0,12. Patients from group 3 demonstrated no late gadolinium enhancement on CMR images but increased TGF-β1 level in the serum.

Conclusion. Focal myocardial fibrosis is not related to the LBBB. Patients with idiopathic LBBB are characterized by increased TGF-β1 level with no myocardial fibrosis. Diffuse inflammation in LBBB-DCM patients may contribute to the progression of systolic dysfunction but is not the reason for LBBB formation.

About the authors

Elena M. Rimskaya

Chazov National Medical Research Center of Cardiology

Author for correspondence.
Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0002-0063-5474

кандидат медицинских наук, ст. научный сотрудник отд. клинической электрофизиологии и рентгенхирургических методов лечения нарушений ритма сердца

Russian Federation, Moscow

Olga V. Stukalova

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0001-8377-2388

кандидат медицинских наук, ст. научный сотрудник отд. томографии

Russian Federation, Moscow

Olga P. Aparina

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0002-4414-698X

кандидат медицинских наук, научный сотрудник отд. клинической электрофизиологии и рентген-хирургических методов лечения нарушений ритма сердца

Russian Federation, Moscow

Nataliia A. Mironova

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0002-2374-3718

кандидат медицинских наук, ст. научный сотрудник отд. клинической электрофизиологии и рентген-хирургических методов лечения нарушений ритма сердца

Russian Federation, Moscow

Tatiana V. Kuznetsova

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0001-5403-3885

кандидат медицинских наук, ст. научный сотрудник лаб. нейрогуморальной регуляции сердечно-сосудистых заболеваний

Russian Federation, Moscow

Petr V. Chumachenko

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru

кандидат медицинских наук, ст. научный сотрудник лаб. патоморфологии сердечно-сосудистых заболеваний

Russian Federation, Moscow

Sergey P. Golitsyn

Chazov National Medical Research Center of Cardiology

Email: eleno4ka_g@mail.ru
ORCID iD: 0000-0001-9913-9974

доктор медицинских наук, профессор, рук. отд. клинической электрофизиологии и рентген-хирургических методов лечения нарушений ритма сердца

Russian Federation, Moscow

References

  1. Римская Е.М., Миронова Н.А., Соколов С.Ф., Голицын С.П. Блокада левой ножки пучка Гиса – дилатационная кардиомиопатия – сердечная недостаточность: общие звенья замкнутой цепи патогенеза. Кардиология. 2023;63(2):68-76 [Rimskaya EM, Mironova NA, Sokolov SF, Golitsyn SP. Left bundle branch block – dilated cardiomyopathy – heart failure: common links in the closed pathogenetic chain. Kardiologiia. 2023;63(2):68-76 (in Russian)]. doi: 10.18087/cardio.2023.2.n1773
  2. Kuhn H, Breithardt G, Knieriem HJ, et al. Prognosis and possible presymptomatic manifestations of congestive cardiomyopathy (COCM). Postgraduate Medical Journal. 1978;54(633):451-61. doi: 10.1136/pgmj.54.633.45
  3. Blanc JJ, Fatemi M, Bertault V, et al. Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy. Europace. 2005;7(6):604-10. doi: 10.1016/j.eupc.2005.06.005
  4. Leyva F, Foley PW, Chalil S, et al. Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13(1):29. doi: 10.1186/1532-429X-13-29
  5. Gulati A, Jabbour A, Ismail TF, et al. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA. 2013;309(9):896-908. doi: 10.1001/jama.2013.1363
  6. Upadhyay GA, Cherian T, Shatz DY, et al. Intracardiac Delineation of Septal Conduction in Left Bundle-Branch Block Patterns: Mechanistic Evidence of Left Intrahisian Block Circumvented by His Bundle Pacing. Circulation. 2019;139(16):1876-88. doi: 10.1161/CIRCULATIONAHA.118.038648
  7. Khan R, Sheppard R. Fibrosis in heart disease: understanding the role of transforming growth factor-beta in cardiomyopathy, valvular disease and arrhythmia. Immunology. 2006;118(1):10-24. doi: 10.1111/j.1365-2567.2006.02336.x
  8. Nattel S. Molecular and cellular mechanisms of atrial fibrosis in atrial fibrillation. JACC Clin Electrophysiol. 2017;3(5):425-35. doi: 10.1016/j.jacep.2017.03.002
  9. Российское кардиологическое общество (РКО). Хроническая сердечная недостаточность. Клинические рекомендации. 2020. Российский кардиологический журнал. 2020;25(11):4083 [Russian Society of Cardiology (RSC). 2020 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2020;25(11):4083 (in Russian)]. doi: 10.15829/1560-4071-2020-4083
  10. Арутюнов Г.П., Палеев Ф.Н., Моисеева О.М., Миокардиты у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(11):4790 [Arutyunov GP, Paleev FN, Moiseeva OM, et al. 2020 Clinical practice guidelines for Myocarditis in adults. Russian Journal of Cardiology. 2021;26(11):4790 (in Russian)]. doi: 10.15829/1560-4071-2021-4790
  11. Гупало Е.М., Миронова Н.А., Рогова М.М., и др. Исследование клинико-инструментальных и морфологических показателей, а также экспрессии Коксаки-аденовирусного рецептора у больных воспалительными заболеваниями миокарда. Кардиология. 2014;54(5):8-15 [Gupalo EM, Mironova NA, Rogova MM, et al. Assessment of Clinical-Instrumental, Morphological Data and Expression of Coxsackie Adenovirus Receptor in Patients With Inflammatory Cardiac Pathology. Kardiologiia. 2014;54(5):8-15 (in Russian)]. doi: 10.18565/cardio.2014.5.8-15
  12. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC white paper. J Am Coll Cardiol. 2009;53:1475-87. doi: 10.1016/j.jacc.2009.02.007
  13. Стукалова О.В., Гупало Е.М., Чумаченко П.В., и др. Возможности магнитно-резонансной томографии в диагностике миокардита с различным клиническим течением. Терапевтический архив. 2019; 91(4):28-36 [Stukalova OV, Gupalo EM, Chumachenko PV, et al. The value of cardiovascular magnetic resonance in myocarditis withdifferent clinical presentation. Terapevticheskii Arkhiv (Ter. Arkh). 2019;91(4):28-36 (in Russian)]. doi: 10.26442/00403660.2019.04.000078
  14. Sze E, Daubert JP. Left bundle branch block-induced left ventricular remodeling and its potential for reverse remodeling. J Interv Card Electrophysiol. 2018;52(3):343-52. doi: 10.1007/s10840-018-0407-2
  15. Blanc JJ, Fatemi M, Bertault V, et al. Evaluation of left bundle branch block as a reversible cause of non-ischaemic dilated cardiomyopathy with severe heart failure. A new concept of left ventricular dyssynchrony-induced cardiomyopathy. Europace. 2005;7(6):604-10. doi: 10.1016/j.eupc.2005.06.005
  16. Angelini A, Calzolari V, Calabrese F, et al. Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart. 2000;84:245-50. doi: 10.1136/heart.84.3.245
  17. Francone M, Chimenti C, Galea N, et al. CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imaging. 2014;7:254-63. doi: 10.1016/j.jcmg.2013.10.011
  18. Yu Q, Horak K, Larson DF. Role of T lymphocytes in hypertension-induced cardiac extracellular matrix remodeling. Hypertension. 2006;48(1):98-104. doi: 10.1161/01.HYP.0000227247.27111.b2
  19. Lenegre J. Etiology and pathology of bilateral bundle branch block in relation to complete heart block. Prog Cardiovasc Dis. 1964;6:409-44. doi: 10.1016/s0033-0620(64)80001-3
  20. Lev M. The pathology of complete atrioventricular block. Prog Cardiovasc Dis. 1964;6:317-26. doi: 10.1016/s0033-0620(64)80005-0

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. EMB specimens from patients with dilated cardiomyopathy: a, c – group 1 patients (with left bundle branch block); b, d – group 2 patients (without left bundle branch block); a, b – EMB specimens immunohistochemically stained for inflammatory CD3 T-lymphocytes (brown); a – single cells are present in the specimen, b – focal cell infiltrate. Cell nuclei are stained with hematoxylin; c, d – assessment of interstitial fibrosis in endomyocardial biopsy specimens stained with Masson's trichrome stain. Blue indicates areas of interstitial myocardial fibrosis.

Download (543KB)
Indexing metadata
3. Fig. 2. The nature of the foci of delayed contrast enhancement according to MRI in the examined patients.

Download (132KB)
Indexing metadata
4. Fig. 3. Images of MRI with delayed contrast enhancement, 4-chamber long axis of the left ventricle: a, c – group 1 patients (dilated cardiomyopathy with left bundle branch block); b, d – group 2 patients (dilated cardiomyopathy without left bundle branch block); a, b – uniform focal "striae"-type accumulation of the contrast agent in the interventricular septum (indicated by arrows); c, d – patients without signs of focal accumulation of contrast agent in the myocardium.

Download (110KB)
Indexing metadata
5. Fig. 4. Percentage of patients with transforming growth factor β1 exceeding the reference values in groups 1, 2 and 3.

Download (96KB)
Indexing metadata

Copyright (c) 2024 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies