Comparison of left ventricular volume and left ventricular ejection fraction by 2-dimensional echocardiography by Simpson’s method & real time 3-dimensional echocardiography in patients of normal conduction with normal left ventricular function, complete left bundle branch block with normal left ventricular function and with left ventricular dysfunction

Abstract

Background and objectivesLeft Bundle Branch Block (LBBB) causes dyssynchrony and asymmetrical contraction of left ventricle (LV), which affects hemodynamics of LV i.e. reduction in LV ejection fraction (LVEF) and increase in LV volumes. Real time 3-Dimensional echocardiography (RT 3-DE) has been reported as a more reproducible and better modality for assessment of LV volume and also it allows comparison of synchrony of all ventricular segments at once and can be considered an accurate method for the assessment and quantification of LV volumes and LV function.1-3. In this study, we quantified and compared LV volumes in patients of complete LBBB with LV dysfunction, complete LBBB with normal LV function and normal conduction with normal LV function, by 2DE & RT3-DE. MethodologyThis single centre case control study was conducted for one year in our hospital, The study included 191 patients, which were divided into three groups, Group I→LBBB with LV dysfunction [n=66], Group II→LBBB with normal LV function [n=60] and Group III→Individuals with normal conduction with normal LV function [n=65].2-DE and RT-3DE was performed in all 191 patients, data collected and analysed were compared among three groups. ResultsIn this study the LVEF and LV volumes based on 2DE was significantly high compared to RT-3DE. LVEF with a difference of 4.32±6.47% (p<0.001) in group I, 3.96±3.05% (p<0.001) in group II and 5.27±3.26% (p<0.001) in group III. LVEDV with a difference of 12.91±22.13 mL (p<0.001) in group I, 5.57±11.53 mL (p<0.001) in group II and a difference of 10.98±10.45 mL (p<0.001) group III. LVESV with a difference of 9.25±15.26 mL (p<0.001) in group I and group III with difference being 3.55±5.09 mL (p<0.001). ConclusionLVEF and LV volumes (LVEDV and LVESV) were higher by 2DE and significantly lesser by RT3DE, 2DE tends to calculate the LV volumes higher as it considers LV in the form of cylinder, which was statistically significant with 2DE and RT3DE. As RT3DE calculates LV volumes more accurately, RT3DE is more standardised method to calculate LV volumes in the presence of LBBB.