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Prevalence and Long‐Term Prognosis of Patients with Complete Bundle Branch Block (Right or Left Bundle Branch) with Normal Left Ventricular Ejection Fraction Referred for Stress Echocardiography
Author(s) -
Supariwala Azhar A.,
Po Jose Ricardo F.,
Mohareb Sameh,
Aslam Farhan,
Kaddaha Firas,
Mian Zainab I.,
Chaudhry Farhan,
Otokiti Ahmed,
Chaudhry Farooq A.
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12680
Subject(s) - medicine , left bundle branch block , cardiology , ejection fraction , bundle branch block , dobutamine , coronary artery disease , right bundle branch block , heart failure , electrocardiography , hemodynamics
Background The prognostic value of stress echocardiography ( SE ) in patients with complete bundle branch blocks ( BBB ) with normal left ventricular ejection fraction ( LVEF ) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF . Methods We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow‐up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All‐cause mortality data were obtained from the Social Security Death Index. Results There were 222 (3%) patients with right bundle branch block ( RBBB ) and 50 (0.7%) patients with left bundle branch block ( LBBB ). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors ( OR = 3.3; 95% CI : 1.86–5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB , 2.5%/year for patients with RBBB , and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE , those with LBBB had similar mortality to those without LBBB ( HR = 0.9; 95% CI : 0.4–2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all‐cause mortality ( HR = 2.4; 95% CI : 1.4–4.2; P = 0.002). Conclusion A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.