Is septal glucose metabolism altered in patients with left bundle branch block and ischemic cardiomyopathy?

Unlabelled: Left bundle branch block (LBBB) is common in patients with heart failure (HF) and contributes to left ventricular (LV) dysfunction. The abnormal septal motion may alter septal metabolic demand but this has not been well characterized in patients with ischemic cardiomyopathy (ICM) and LV dysfunction. The aim of this study was to determine the effect of LBBB on septal metabolism in patients with ICM, LV dysfunction, and LBBB.

Methods: Fifty-three patients with LV dysfunction and ICM were identified: 34 with LBBB, 19 with normal QRS (
Results: (18)F-FDG uptake in the septum was reduced in patients with LBBB (64.0% +/- 15.4%) compared with control patients (74.9% +/- 14.3%; P < 0.05). Mean septal R-MM was greater in patients with LBBB (19.1% +/- 15.3%) versus control patients (4.7% +/- 10.6%; P < 0.05). However, 32% (11/34) of patients with LBBB did not demonstrate septal R-MM, 91% (10/11) of whom demonstrated lateral wall perfusion defects. Of the 68% (23/34) of patients with LBBB and septal R-MM, 52% (12/23) demonstrated lateral wall perfusion defects (P < 0.05). There was a significant difference in the percentage of the lateral wall with scar between those with septal R-MM (9.3% +/- 10.5%) and those without (19.9% +/- 14.3%; P < 0.05).

Conclusion: Previously, LBBB was believed to be characterized by reduced glucose metabolism relative to perfusion in the septum; however, this is not always the case in ICM. LBBB is not associated with septal R-MM in >30% of this patient population. Absence of this finding was often associated with lateral wall perfusion defects, suggesting an alteration in the metabolic demand on the septum. This may have implications for HF therapies such as resynchronization and requires further study.