Document Detail

Prognostic significance of left anterior hemiblock in patients with suspected coronary artery disease.
MedLine Citation:
PMID:  16139137     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study was designed to assess the functional and prognostic significance of left anterior hemiblock (LAHB) in patients with no history of myocardial infarction referred for dobutamine stress echocardiography (DSE). BACKGROUND: The significance of isolated LAHB in patients with suspected coronary artery disease (CAD) is unclear. METHODS: We studied 1,187 patients with suspected CAD and no history of myocardial infarction who underwent DSE and were followed for occurrence of cardiac death. RESULTS: Left anterior hemiblock was detected on baseline electrocardiogram in 159 patients (13%). Ischemia occurred more frequently in patients with LAHB (43% vs. 33%, p = 0.02). During a mean follow-up of 5.0 +/- 2.5 years, 125 patients (11%) died of cardiac causes. The annual cardiac death rate was 4.9% in patients with LAHB and 1.9% for patients without (p < 0.0001). Patients with both LAHB and an abnormal DSE had the highest annual cardiac death rate (6.3%). In a Cox multivariable analysis, independent predictors of cardiac death were age, smoking, history of heart failure, diabetes, and ischemia. Left anterior hemiblock was independently associated with increased risk of cardiac death among patients with normal DSE (hazard ratio 1.8, 95% confidence interval 1.1 to 3.8) and in patients with abnormal DSE (hazard ratio 1.7, 95% confidence interval 1.1 to 2.7). CONCLUSIONS: In patients with suspected CAD referred for stress testing, LAHB is associated with increased risk of cardiac death. This risk is persistent after adjustment for major clinical data and abnormalities on the stress echocardiogram. Therefore, isolated LAHB should not be considered a benign electrocardiographic abnormality in these patients.
Elena Biagini; Abdou Elhendy; Arend F L Schinkel; Stefan Nelwan; Vittoria Rizzello; Ron T van Domburg; Claudio Rapezzi; Guido Rocchi; Maarten L Simoons; Jeroen J Bax; Don Poldermans
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  46     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-05     Completed Date:  2005-12-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  858-63     Citation Subset:  AIM; IM    
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
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MeSH Terms
Bundle-Branch Block / physiopathology*,  ultrasonography
Coronary Artery Disease / mortality,  physiopathology*,  ultrasonography
Echocardiography, Stress
Middle Aged
Prospective Studies
Risk Assessment
Risk Factors
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography

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

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