ORIGINAL RESEARCH PAPER STUDY OF SPECKLE TRACKING ECHOCARDIOGRAPHY IN ISCHEMIC AND NON ISCHEMIC LEFT BUNDLE BRANCH BLOCK Dr. Kota Sabari Girish* DNB Registrar, Dept of Cardiology, Apollo Main Hospitals, Chennai-600006. *Corresponding Author Dr. Prakash Chand Jain Consultant, Dept of Cardiology, Apollo Main Hospitals, Chennai-600006. Dr.Vinodh Kumar Paulpandi Consultant, Dept of Cardiology, Apollo Main Hospitals, Chennai-600006. Dr.Seshagiri Raju D DNB Registrar, Dept of Cardiology, Apollo Main Hospitals, Chennai-600006. Balasubramaniam Ramakrishnan Senior Biostatistician, DME ofce, Apollo Main Hospitals, Chennai-600006. INTRODUCTION Isolated Left Bundle Branch Block (LBBB)refers to asymptomatic LBBB in young subjects without any structural heart disease, without any cardiovascular risk factors, has not been seen to affect those individuals and is generally associated with a good prognosis. In subjects older than 40 years of age, it has been seen that LBBB affects 1 cardiovascular events and there by acts as a prognostic marker . Contrary to the right bundle branch, the left ventricular conduction system is a large, diffuse structure that typically requires a signicant insult to result in widespread injury. If LBBB is present in the context of myocardial infarction, the infarction site is usually anterior or anteroseptal, and the MI usually involves a large territory of the 2 myocardium . The most widely accepted tools to aid in diagnosing MI in the presence of LBBB are the Sgarbossa criteria, which is rst introduced over 20 years ago to substantially improve the diagnostic accuracy for MI in the presence of LBBB. Notwithstanding, stress testing within sight of LBBB is complicated because of the higher paces of false-positive discoveries, regardless of whether imaging modalities are utilized. As a result of these constraints, patients with LBBB are frequently alluded to invasive Coronary angiography 3 (CAG) to exclude Coronary artery disease (CAD). Speckle tracking echocardiography is one of the developing modalities to analyze ischemia, ischemic wall motion abnormalities are often associated with passive motion, such as passive expansion and recoil and tethering from adjacent segments, strain imaging has the unique advantage of differentiating active contraction from passive motion, which is visually challenging. In this manner, it can be utilized to 4 analyze LBBB brought about by ischemia non-invasively. This obviated the need to study further the role of speckle tracking in the determination of the etiology of LBBB to prevent unnecessary 5 invasive tests. In this study, we analyzed the 2D Echo Spectral imaging in patients presenting with symptomatic LBBB admitted in cardiology department at Apollo Main Hospitals, Chennai. We assess coronary angiogram in patients presenting with symptomatic LBBBand determine the efcacy of 2D spectral imaging by sensitivity analysis. MATERIAL AND METHODS This is a prospective observational study involving 95 patients who cameto Cardiology outpatient department (OPD) or Emergency department at Apollo Main Hospitals, Chennai with baseline 12 lead electrocardiography of complete LBBB (QRS 120 ms) in Sinus rhythm and presented with history of Angina on exertion – Canadian Cardiovascular Class 2/3, Acute onset chest pain, Dyspnea on exertion - NYHA class II/III, Acute onset class IV dyspnea are included in the study. The exclusion criteria involves patients with known case of Valvular Heart Diseases, CAD, ischemic and non-ischemic cardiomyopathy, Congenital heart disease, patients with poor echocardiographic window not suitable for Speckle echocardiographic analysis and patients in whom CAG could not be done Data collection It included baseline patient characteristics including atherosclerotic risk factors, ECG, echocardiography, routine research center work, and statistical and clinical information. The associated conditions considered in the study were hypertension, dyslipidemia, diabetes mellitus. Patients with complete LBBB with the above-mentioned symptoms were admitted for the treatment and stabilization and further classied into three groups on the basis of ejection fraction (2D Planimetry method) 1. LVEF > 50 % (Group 1) 2. LVEF 35 to 50 % (Group 2) INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH Cardiology International Journal of Scientific Research 69 Volume - 10 | Issue - 07 | July - 2021 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr ABSTRACT Background:Speckle tracking echocardiography parameters like Global longitudinal strain (GLS) and Global circumferential strain (GCS) are developing modalities to analyze ischemia, which has the unique advantage of differentiating active contraction from passive motion. Speckle tracking echocardiography can be utilized as a non invasive technique to analyze and differentiate Left Bundle Branch Block (LBBB) caused by ischemia. Aims & objectives: Tostudy the 2D Echo Spectral imaging in patients presenting with symptomatic LBBB, to assess their coronary angiogram and determine the efcacy of 2D spectral imaging by sensitivity analysis Methods: Theprospective observational study was conducted in Apollo Hospitals, Chennai in the Department of Cardiology. A total of 95 patients with symptomatic LBBB were included in our study. GLS and GCS were measured followed by Coronary Angiogram. Speckle tracking echocardiography ndings in ischemic and non-ischemic LBBB were correlated at our center. Results:The mean GLS of Ischemic subgroup (N=50) patients is -10.90±3.54. whereas the mean GLS of non-ischemic subgroup (N = 45) is - 14.41±4.79. On analyzing and correlating GLS between both the groups, it was found to have statistically signicant differences between ischemic and non-ischemic patients with p-value = 0.001.The mean GCS of non-ischemic patients (N = 45) is - 15.100 ± 5.07. The mean GCS of Ischemic patients (N = 50) is - 13.30 ± 3.48.There are statistically signicant differences in GCS between ischemic and non-ischemic patients, p-value = 0.006. Conclusion: 2D Echo Spectral imaging parameters like GLS and GCS are useful in discriminating Ischemic and Non ischemic aetiology in the patients presenting with LBBB. KEYWORDS Left Bundle Branch Block, Global Longitudinal Strain,Global circumferential strain