Congestive Heart Failure
Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: A report from the Italian network on congestive heart failure*,**,

https://doi.org/10.1067/mhj.2002.121264Get rights and content

Abstract

Background A deleterious effect of complete left bundle-branch block (LBBB) on left ventricular function has been established. Nevertheless, the independent effect of a widened QRS on mortality rate in congestive heart failure (CHF) is still controversial. Therefore, we carried out this analysis to determine whether LBBB is an independent predictor of mortality in CHF. Methods and Results We analyzed the large Italian Network on CHF Registry of unselected outpatients with CHF of different causes. The registry was established by the Italian Association of Hospital Cardiologists in 1995. Complete 1-year follow-up data were available for 5517 patients. The main underlying cardiac diagnosis was ischemic heart disease in 2512 patients (45.6%), dilated cardiomyopathy in 1988 patients (36.0%), and hypertensive heart disease in 714 patients (12.9%). Other causes were recorded in the remaining 303 cases (5.5%). LBBB was present in 1391 patients (25.2%) and was associated with an increased 1-year mortality rate from any cause (hazard ratio, 1.70; 95% confidence interval, 1.41 to 2.05) and sudden death (hazard ratio, 1.58; 95% confidence interval, 1.21 to 2.06). Multivariate analysis showed that such an increased risk was still significant after adjusting for age, underlying cardiac disease, indicators of CHF severity, and prescription of angiotensin-converting enzyme inhibitors and β-blockers. Conclusion LBBB is an unfavorable prognostic marker in patients with CHF. The negative effect is independent of age, CHF severity, and drug prescriptions. These data may support the rationale of randomized trials to verify the effects on mortality rate of ventricular resynchronization with multisite cardiac pacing in patients with CHF and LBBB. (Am Heart J 2002;143:398-405.)

Section snippets

Study design, collected data, and definitions

Data for this analysis were originated from the database of the Italian Network CHF Registry,19 a survey designed in 1995 by an ad hoc committee of the Italian Association of Hospital Cardiologists (Florence, Italy). One-hundred fifty cardiologic centers accepted participation in the study. Centers were distributed across the national territory and were more frequently located in Northern (46%) than in Central (24%) or Southern (30%) Italy, well representing the whole country. Short training

Results

The study population of 5517 patients had a mean age of 63 ± 12 years (range, 14 to 96 years) and included 1295 women (23.5%) and 1544 cases (28.0%) that were classified in NYHA class III to IV. The 1076 patients with complete 1-year follow-up data who were excluded from this analysis had a similar age (65 ± 12 years; range, 17 to 91 years) but a larger prevalence of women (38.6%; P <.01) and of NYHA classification III to IV (38.8%; P <.01).

Discussion

The association of a wide QRS with increased mortality rate in CHF has been repeatedly investigated, but results have been conflicting. Although some studies showed that a wide QRS has an independent, unfavorable prognostic significance and increases the mortality rate of patients with CHF during periods of follow-up examination extended to 5 years,11, 12, 14 other studies adopting similar multivariate approaches did not confirm this finding.10, 13, 16 Such discrepancies may arise from the

References (40)

  • F Follath et al.

    Etiology and response to drug treatment in heart failure

    J Am Coll Cardiol

    (1998)
  • DT. Kelly et al.

    Our future society. A global challenge

    Circulation

    (1997)
  • C Opasich et al.

    Peak exercise oxygen consumption in chronic heart failure: toward efficient use in the individual patient

    J Am Coll Cardiol

    (1998)
  • CL Grines et al.

    Functional abnormalities in isolated left bundle-branch block. The effect of interventricular asynchrony

    Circulation

    (1989)
  • HB Xiao et al.

    Effect of left bundle-branch block on diastolic function in dilated cardiomyopathy

    Br Heart J

    (1991)
  • A Fappani et al.

    The prognosis of the patient with heart failure: an analysis of the most significant clinical and instrumental parameters

    Cardiologia

    (1991)
  • Y Koga et al.

    Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy

    Heart Vessels

    (1993)
  • A Gavazzi et al.

    Dilated cardiomyopathy: a new natural history? The experience of the Italian Multicenter Cardiomyopathy Study (SPIC)

    G Ital Cardiol

    (1995)
  • X Huang et al.

    Clinical significance of complete left bundle-branch block in dilated cardiomyopathy

    Chin Med Sci J

    (1995)
  • Y Juilliere et al.

    Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy

    Eur Heart J

    (1997)
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    *

    The Italian Network on Congestive Heart Failure Registry was supported in part by Merck Sharp & Dohme spa Italy.

    **

    See the Appendix for a complete list of participating Centers and Investigators.

    Reprint requests: Aldo P. Maggioni, MD, ANMCO Research Center — Via La Marmora 34, 50121 Florence, Italy.E-mail: [email protected]

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