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Low lead one ratio predicts clinical outcomes in left bundle branch block
Author(s) -
Loring Zak,
Atwater Brett D.,
Xia Xiaojuan,
Axelsson Jimmy,
Klem Igor,
Nijveldt Robin,
Schelbert Erik B.,
Couderc JeanPhilippe,
Strauss David G.,
Ugander Martin,
Wieslander Björn
Publication year - 2019
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.13875
Subject(s) - medicine , ejection fraction , left bundle branch block , cardiology , cohort , odds ratio , cardiomyopathy , receiver operating characteristic , cardiac resynchronization therapy , heart failure
We evaluated the association between a novel electrocardiographic (ECG) marker of late, rightward electrocardiographic forces (termed the lead one ratio [LOR]), and left ventricular ejection fraction (LVEF), myocardial scar, and clinical outcomes in patients with left bundle branch block (LBBB). Methods and Results LOR was calculated in patients with LBBB from a derivation cohort (n = 240) and receiver operator characteristic curves identified optimal threshold values for predicting myocardial scar and LVEF less than 35%. An independent validation cohort of patients with LBBB (n = 196) was used to test the association of LOR with the myocardial scar, LVEF, and the likelihood of death, heart transplant or left ventricular assist device (LVAD) implantation. The optimal thresholds in the derivation cohort were LOR less than 13.7 for identification of scar (sensitivity 55%, specificity 80%), and LOR less than 12.1 for LVEF less than 35% (sensitivity 49%, specificity 80%). In the validation cohort, LOR less than 13.7 was not associated with scar size or presence ( P > 0.05 for both). LOR less than 12.1 was associated with lower LVEF (30 [20‐40] versus 40 [25‐55]%; P = 0.002) and predicted LVEF less than 35% in univariable (odds ratio [OR], 2.2 [1.2‐4.1]; P = 0.01) and multivariable analysis (OR, 2.2 [1.2‐4.3]; P = 0.02). LOR less than 12.1 was associated with scar presence when patients with nonischemic cardiomyopathy were excluded (OR = 7.2 [1.5‐33.2]; P = 0.002). LOR less than 12.1 had an adjusted hazard ratio of 1.53 ([1.05‐2.21]; P = 0.03) for death, transplant or LVAD implantation. Conclusions In conclusion, ECG LOR less than 12.1 predicts reduced‐LV systolic function and poorer prognosis in patients with LBBB.