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Prolonged QRS duration (QRS >/=170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?
MedLine Citation:
PMID:  11685159     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left bundle branch block (LBBB) is commonly associated with structural heart disease and left ventricular dysfunction. We propose that the QRS duration and degree of left-axis deviation (LAD) identify significant left ventricular systolic dysfunction in patients with LBBB. METHODS: In this prospective study the ejection fraction (EF) of 300 consecutive patients with LBBB was evaluated by echocardiography. The relationship between QRS duration and LAD (axis between -30 degrees and -90 degrees ) and EF were derived. RESULTS: There was no significant difference in age, sex, presence of ischemic or nonischemic cardiomyopathy and valvular heart disease, and EF among the patients with or without LAD. The EF of patients with QRS >/=170 milliseconds with LAD (n = 20) and without LAD (n = 18) was 25% +/- 16% and 23% +/- 13%, respectively (P =.71). The mean EF (24% +/- 10%) of the patients with a QRS duration of >/=170 milliseconds (n = 38) was significantly lower than the mean EF (36% +/- 16%) of the patients with a QRS duration of <170 milliseconds (n = 262, P <.015). The QRS duration also had a significant (P <.001) inverse correlation with EF (R = 0.37, adjusted R (2) = 0.13, SE of estimate = 16.21). However, the QRS axis was not significantly correlated with EF and did not have added predictive value. CONCLUSIONS: The QRS duration has a significant inverse relationship with EF and prolongation of QRS duration (>/=170 milliseconds) in the presence of LBBB is a marker of significant left ventricular systolic dysfunction. The presence of LAD in LBBB does not signify a further decrease in EF.
M K Das; K Cheriparambil; A Bedi; J Kassotis; C V Reddy; M Makan; C C Dunbar; B Saul
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  142     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-10-30     Completed Date:  2002-01-08     Revised Date:  2007-09-11    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  756-9     Citation Subset:  AIM; IM    
New York Presbyterian Hospital-Cornell University Medical College, New York, NY 10021, USA.
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MeSH Terms
Bundle-Branch Block / diagnosis*,  epidemiology
Electrocardiography / statistics & numerical data*
Prospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / diagnosis*,  epidemiology

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