Background:A growing body of evidence suggests that the presence of a right bundle branch block (RBBB) is a negative prognostic indicator in patients with and without preexisting heart disease. Even though electromechanical activation of the right ventricle (RV) in patients with RBBB and pulmonary hypertension (PH) has been investigated; a direct comparison of the presence of RBBB, on the duration of RV mechanical systole using echocardiography has not been studied.Materials and Methods:In this retrospective study, we analyzed the echocardiograms of 40 patients by measuring the magnitude and timing of tricuspid annulus plane systolic excursion (TAPSE) and tricuspid annulus systolic velocity (TA S’). Patients were selected to form four groups of ten patients based on the presence or absence of RBBB and PH to determine if RBBB has any effect on the time-to-peak of TAPSE or TA S’, which for our purposes serves as a measure of duration of RV mechanical systole.Results:Our results demonstrate that RBBB leads to a measurable prolongation of TAPSE and TA S’ in patients without PH. Time-to-peak of TAPSE or TA S’ was not significantly prolonged in patients with PH.Conclusions:The results of this pilot study show that RV mechanical systole is prolonged in patients with RBBB, and the addition of PH attenuates this change. Additional prospective studies are now required to elucidate further the electrical and mechanical dyssynchrony that occurs as a result of RBBB, and how these new echocardiographic measurements can be applied clinically to risk stratify patients with RBBB and PH.

Background:The ischemic cascade has long been known to begin with diastolic dysfunction before detectable systolic abnormalities. The advent of speckle-tracking imaging and velocity vector imaging (VVI) has provided accurate and reproducible interpretation of systolic abnormalities in numerous disease processes; however, this imaging tool has been only recently been proposed for detecting diastolic abnormalities.Methods:We analyzed pre and poststress echocardiography images of ten patients using VVI. We calculated normalized strain time (NST) as the duration strain was at least 90% of the measured peak and subtracted pre and poststress NST to calculate prolongation of NST as a sign of diastolic dysfunction. These intervals were measured from left ventricular longitudinal cine images obtained from two and 4-chamber in five patients not only with a positive stress echocardiographic response but also anatomy confirmed by coronary angiography. They were then compared to five patients without coronary artery disease (CAD).Results:Differences in pre and poststress NST measured in the apical 4-chamber view were greater in CAD patients than without (40 ± 16 vs. 12 ± 19; P = 0.04).Conclusions:Significant diastolic abnormalities were detected using a semi-automated VVI analysis in the poststress recovery period. A prospective study is now required in a larger number of patients to correlate the development of diastolic strain abnormalities with extent and location of CAD.