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Right and left bundle branch block as predictors of long‐term mortality following myocardial infarction
Author(s) -
Lewinter Christian,
TorpPedersen Christian,
Cleland John G.F.,
Køber Lars
Publication year - 2011
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfr130
Subject(s) - medicine , cardiology , left bundle branch block , myocardial infarction , hazard ratio , heart failure , bundle branch block , right bundle branch block , confidence interval , trandolapril , electrocardiography , blood pressure , angiotensin converting enzyme , ace inhibitor
Aims Patients with acute myocardial infarction (MI) with bundle branch block (BBB) have a poor prognosis, but distinction between left (L)‐ and right (R)‐sided BBB is seldom made in epidemiological studies. We studied long‐term mortality associated with RBBB and LBBB in the TRAndolapril Cardiac Evaluation (TRACE) study. Methods and results TRACE screened consecutive patients presenting with an MI and recorded clinical, electro‐ and echo‐cardiographic variables. Subsequently, deaths were recorded during a minimum follow‐up of 15 years. In total, 6676 consecutive patients with MI were hospitalized at 27 centres in Denmark. Of these, 533 (8%) had BBB, of whom 260 (4%) had RBBB and 273 (4%) had LBBB. Overall, 5196 (78%) patients died, 256 (94%) with LBBB and 235 (90%) with RBBB compared with 4705 (77%) of those without BBB ( P < 0.001). In multivariable analyses, hazard ratios (HRs) of RBBB and LBBB were 1.23 [95% confidence interval (CI), 1.07–1.42] and 1.05 (95% CI, 0.91–1.20), respectively. There was interaction between each type of BBB and left ventricular (LV) systolic function ( P = 0.02). Right BBB was associated with a worse prognosis in patients with reduced LV systolic function [HR = 1.31 with wall motion index (WMI) ≤ 1.5 (95% CI, 1.11–1.55] while LBBB had a poor prognosis in patients with preserved LV systolic (HR if WMI > 1.5, 1.70; 95% CI, 1.12–2.57). Conclusions Right BBB was a predictor of increased mortality in patients with reduced LV systolic function, whereas LBBB was a marker of increased mortality in patients with preserved LV systolic function.