| Concordant versus discordant left bundle branch block in heart failure patients: novel clinical value of an old electrocardiographic diagnosis. | |
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MedLine Citation:
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PMID: 20350699 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Comparative Study; Journal Article Date: 2010-01-18 |
Journal Detail:
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Title: Journal of cardiac failure Volume: 16 ISSN: 1532-8414 ISO Abbreviation: J. Card. Fail. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-30 Completed Date: 2010-10-29 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9442138 Medline TA: J Card Fail Country: United States |
Other Details:
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Languages: eng Pagination: 320-6 Citation Subset: IM |
Copyright Information:
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(c) 2010 Elsevier Inc. All rights reserved. |
Affiliation:
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Postgraduate School of Cardiology, University of Florence, Florence, Italy. |
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| MeSH Terms | |
Descriptor/Qualifier:
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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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