Document Detail


Concordant versus discordant left bundle branch block in heart failure patients: novel clinical value of an old electrocardiographic diagnosis.
MedLine Citation:
PMID:  20350699     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Over the last 50 years left bundle branch block (LBBB) has been defined as homophasic (concordant: cLBBB) or heterophasic (discordant: dLBBB) when associated with a positive or negative T wave in leads I and V5-V6, respectively. LBBB is recognized as an adverse prognostic factor in heart failure (HF). The prevalence and clinical significance of cLBBB and dLBBB in HF patients are unknown. METHODS AND RESULTS: A total of 897 consecutive systolic HF patients (age 65 +/- 13 years, left ventricular ejection fraction [LVEF], 34 +/- 10%) underwent clinical characterization, electrocardiographic evaluation for LBBB diagnosis and classification, and follow-up for cardiac events (median 37 months, range 1-84). LBBB was diagnosed in 232 patients (26%), cLBBB in 71 (31%), and dLBBB in 161 (69%). The dLBBB patients were older than those with cLBBB, and presented with lower LVEF, greater left ventricular telediastolic diameter and left ventricular mass index, higher level of brain natriuretic peptide, N-terminal pro-brain natriuretic peptide, renin activity, and norepinephrine (all P < .05). At Kaplan-Meier analysis, LBBB (P = .003) and dLBBB (P = .036) were associated with a worse prognosis when the composite end point of sudden death and implantable cardioverter defibrillator shock was considered. CONCLUSIONS: In systolic HF, dLBBB is associated with a worse clinical, neurohormonal, and prognostic profile. LBBB classification could represent a useful tool in routine clinical evaluation.
Authors:
Luigi Padeletti; Alessandro Valleggi; Giuseppe Vergaro; Fabiana Lucà; Carmelo M Rao; Laura Perrotta; Francesco Cappelli; Antonio L'Abbate; Claudio Passino; Michele Emdin
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2010-01-18
Journal Detail:
Title:  Journal of cardiac failure     Volume:  16     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-30     Completed Date:  2010-10-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  320-6     Citation Subset:  IM    
Copyright Information:
(c) 2010 Elsevier Inc. All rights reserved.
Affiliation:
Postgraduate School of Cardiology, University of Florence, Florence, Italy.
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MeSH Terms
Descriptor/Qualifier:
Aged
Bundle-Branch Block / complications,  diagnosis*,  physiopathology*
Electrocardiography / methods*
Female
Follow-Up Studies
Heart Failure / complications,  diagnosis*,  physiopathology*
Humans
Male
Middle Aged
Prospective Studies
Survival Rate / trends

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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