الفهرس 
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Abstract
Introduction: Multiple studies suggest that activation delay of LBBB can be detected from left ventricle mechanical deformation pattern by STE. True LBBB leads to a unique contraction pattern of opposing septal and lateral segments. The septal wall which is early activated regions contracts first while the late activated wall (lateral wall) is pre-stretched and contract late causing a dyssynchronous and inefficient LV pump action.LV pump efficiency is reduced by 30%, by reduction in stroke work and increase in oxygen consumption. This lead to progressive LV dilation and increased wall stress . Recently 2-dimensional STE used to identify clearly the dyssynchronous related to LBBB which can be reversed by CRT and is highly predictive of LV remodeling response. It is, however, unknown whether such patterns are associated with long-term outcome after CRT. The Aim of this study: Detection of true typical mechanical LBBB by speckle tracking echocardiography in Prediction of Long-Term Outcome After Cardiac Resynchronization Therapy. Materials and methods: Forty patients with heart failure with reduced EF, non responsive to medical therapy with their ECG shows left bundle branch block in sinus rhythm and have been planned for cardiac resynchronization therapy underwent 2D echocardiography and speckle training echocardiography were enrolled in this longitudinal prospective observational study with period of six month follow up, (mean age was 59±10.2 years,17 female &23 males), all in Mansoura specialized medical hospital from August 2020 to May 2023. Results: we found that female patients were more response than male patients, as 80 % of females were responder. Regarding ECG we noticed that mean QRS complex width in LBBB 145.1 ± 9.17 and presence of Strauss criteria (found in 92% of responder) were associated with more response. Ischemic cardiomyopathy and sever mitral regurge were negative correlated to response. By 2D echocardiography Apical Rocking and Septal Flash were a predictor of response. Typical LBBB by speckle tracking echocardiography as a tool of detection of actual mechanical dyssnchrony was a great predictor to response. Keywords: Cardiac Resynchronization Therapy (CRT), left bundle branch block (LBBB), left ventricle (LV),electrocardiogram(ECG), speckle tracking echocardiography (STE).