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Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure
Author(s) -
Cinca Juan,
Mendez Ana,
Puig Teresa,
Ferrero Andreu,
Roig Eulalia,
Vazquez Rafael,
GonzalezJuanatey Jose R.,
AlonsoPulpon Luis,
Delgado Juan,
Brugada Josep,
PascualFigal Domingo
Publication year - 2013
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/hft042
Subject(s) - medicine , cardiology , heart failure , left bundle branch block , sudden cardiac death , sudden death , ejection fraction
Aims Intraventricular conduction defects (IVCDs) can impair prognosis of heart failure (HF), but their specific impact is not well established. This study aimed to analyse the clinical profile and outcomes of HF patients with LBBB, right bundle branch block (RBBB), left anterior fascicular block (LAFB), and no IVCDs. Methods and results Clinical variables and outcomes after a median follow‐up of 21 months were analysed in 1762 patients with chronic HF and LBBB ( n = 532), RBBB ( n = 134), LAFB ( n = 154), and no IVCDs ( n = 942). LBBB was associated with more marked LV dilation, depressed LVEF, and mitral valve regurgitation. Patients with RBBB presented overt signs of congestive HF and depressed right ventricular motion. The LAFB group presented intermediate clinical characteristics, and patients with no IVCDs were more often women with less enlarged left ventricles and less depressed LVEF. Death occurred in 332 patients (interannual mortality = 10.8%): cardiovascular in 257, extravascular in 61, and of unknown origin in 14 patients. Cardiac death occurred in 230 (pump failure in 171 and sudden death in 59). An adjusted Cox model showed higher risk of cardiac death and pump failure death in the LBBB and RBBB than in the LAFB and the no IVCD groups. Conclusion LBBB and RBBB are associated with different clinical profiles and both are independent predictors of increased risk of cardiac death in patients with HF. A more favourable prognosis was observed in patients with LAFB and in those free of IVCDs. Further research in HF patients with RBBB is warranted.