| Prognostic implications of intraventricular conduction defects in patients undergoing stress echocardiography for suspected coronary artery disease. | |
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MedLine Citation:
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PMID: 12867229 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: To investigate the prognostic implications of conduction defects in subjects without proven coronary artery disease who had been referred for stress echocardiography. METHODS: The study sample consisted of 1230 patients (574 men and 656 women; mean [+/- SD] age, 63 +/- 10 years) who underwent stress echocardiography with dipyridamole (n = 780) or dobutamine (n = 450) to evaluate suspected coronary artery disease. A summary wall motion score (on a 1 to 4 scale) was calculated. Patients were followed for a mean of 41 +/- 27 months; mortality was the only endpoint. RESULTS: Four hundred and twenty patients (34%) had intraventricular conduction defects on a resting electrocardiogram (173 with complete left bundle branch block, 98 with isolated right bundle branch block, 43 with right bundle branch block with left anterior hemiblock, and 106 with left anterior hemiblock). Ischemia at stress echo (new or worsening of preexisting wall motion abnormality) was found in 250 patients (20%). There were 56 deaths during follow-up; 138 patients underwent revascularization and were censored. Multivariate predictors of mortality were resting wall motion score index (hazard ratio [HR] = 6.0 per unit increase; 95% confidence interval [CI]: 2.3 to 16; P <0.0001), ischemia at stress echo (HR = 3.9; 95% CI: 2.2 to 6.7; P <0.0001), age >65 years (HR = 3.2; 95% CI: 1.7 to 5.9; P <0.0001), hypertension (HR = 1.8; 95% CI: 1.1 to 3.2; P = 0.03), and right bundle branch block with left anterior hemiblock (HR = 3.7; 95% CI: 1.8 to 7.5; P <0.0001). The other three forms of intraventricular conduction defects (left bundle branch block, isolated complete right bundle branch block, and left anterior hemiblock) were not associated with mortality in multivariate analyses, or among the 980 patients who did not have ischemia. CONCLUSION: Right bundle branch block with left anterior hemiblock is an independent predictor of mortality in patients with suspected coronary artery disease undergoing stress echocardiography, whereas isolated right bundle branch block is associated with outcomes similar to those observed in patients with no conduction defects. |
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Authors:
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Lauro Cortigiani; Riccardo Bigi; Guido Gigli; Claudio Coletta; Egidio Mariotti; Claudio Dodi; Costantino Astarita; Eugenio Picano |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of medicine Volume: 115 ISSN: 0002-9343 ISO Abbreviation: Am. J. Med. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-17 Completed Date: 2003-08-18 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0267200 Medline TA: Am J Med Country: United States |
Other Details:
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Languages: eng Pagination: 12-8 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Lucca Hospital, Lucca, Italy. lacortig@tin.it |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Bundle-Branch Block / complications*, diagnosis* Coronary Artery Disease / complications*, diagnosis*, surgery Echocardiography, Stress / methods* Electrocardiography / instrumentation Female Follow-Up Studies Humans Hypertension / complications, diagnosis Male Middle Aged Myocardial Revascularization / methods Prospective Studies |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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