Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Cinca, Juan; Méndez, A.; Puig, Teresa; Ferrero, Andreu; Roig, Eulàlia; Vázquez, Rafael; González-Juanàtey, José Ramón; Alonso‐Pulpón, Luis; Delgado, Juan; Brugada, Josep; Pascual-Figal, Domingo A.

doi:10.1093/eurjhf/hft042

Cited by 28 publications

(22 citation statements)

References 31 publications

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“…RBBB has been associated with previous myocardial infarctions, 5 increased systolic pulmonary artery pressure, 15 and right ventricle (RV) dysfunction in chronic heart failure patients. 16,17 RV dysfunction is an independent predictor of worse survival in chronic heart failure, 18,19 and recently also found in AHF. 20 In that study of consecutively recruited AHF patients, RV dysfunction was found to be present in as much as a fourth of patients, and 70% of them also had pulmonary hypertension assessed with echocardiography.…”

Section: Discussionmentioning

confidence: 76%

Ventricular conduction abnormalities as predictors of long‐term survival in acute de novo and decompensated chronic heart failure

et al. 2015

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AimsData on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRS ≥ 110 ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long‐term survival in patients with de novo AHF and acutely decompensated chronic heart failure (ADCHF).Methods and ResultsWe analysed the admission electrocardiogram of 982 patients from a multicenter European cohort of AHF with 3.9 years' mean follow‐up. Half (51.5%, n = 506) of the patients had de novo AHF. LBBB, and IVCD were more common in ADCHF than in de novo AHF: 17.2% vs. 8.7% (P < 0.001) and 20.6% vs. 13.2% (P = 0.001), respectively, and RBBB was almost equally common (6.9% and 8.1%; P = 0.5), respectively. Mortality during the follow‐up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared with patients with normal ventricular conduction (57.0%); P < 0.001 for both. The impact of RBBB on prognosis was prominent in de novo AHF (adjusted HR 1.93, 1.03–3.60; P = 0.04), and IVCD independently predicted death in ADCHF (adjusted HR 1.79, 1.28–2.52; P = 0.001). Both findings were pronounced in patients with reduced ejection fraction. LBBB showed no association with increased mortality in either of the subgroups. The main results were confirmed in a validation cohort of 1511 AHF patients with 5.9 years' mean follow‐up.ConclusionsConduction abnormalities predict long‐term survival differently in de novo AHF and ADCHF. RBBB predicts mortality in de novo AHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.

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Section: Discussionmentioning

confidence: 76%

Ventricular conduction abnormalities as predictors of long‐term survival in acute de novo and decompensated chronic heart failure

et al. 2015

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“…The first one is a derivation cohort comprised of 2507 patients with chronic HF enrolled in the Spanish Network for the Study of Heart Failure (REDINSCOR registry). This is a prospective, longitudinal, multicentre study designed to assess risk predictors of cardiac mortality and readmissions in ambulatory patients with HF . Patients were consecutively recruited between January 2007 and January 2011 at HF clinics in 18 hospitals.…”

Section: Methodsmentioning

confidence: 99%

“…This is a prospective, longitudinal, multicentre study designed to assess risk predictors of cardiac mortality and readmissions in ambulatory patients with HF. 6,7 Patients were consecutively recruited between January 2007 and January 2011 at HF clinics in 18 hospitals. Inclusion criteria were: (i) age older than 18 years; (ii) prior hospitalization for HF (>24 h) during the previous year; and (iii) the presence of at least one echocardiographic abnormality (LVEF ≤40%, LV end-diastolic diameter ≥60 mm, altered LV relaxation indicating diastolic dysfunction, or thickness of interventricular septum/LV posterior wall ≥14 mm).…”

Section: Study Populationmentioning

confidence: 99%

A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients: the Redin‐SCORE

Álvarez‐García

Ferrero‐Gregori

Puig

et al. 2015

European J of Heart Fail

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AimsPrevention of hospital readmissions is one of the main objectives in the management of patients with heart failure (HF). Most of the models predicting readmissions are based on data extracted from hospitalized patients rather than from outpatients. Our objective was to develop a validated score predicting 1‐month and 1‐year risk of readmission for worsening of HF in ambulatory patients.Methods and resultsA cohort of 2507 ambulatory patients with chronic HF was prospectively followed for a median of 3.3 years. Clinical, echocardiographic, ECG, and biochemical variables were used in a competing risk regression analysis to construct a risk score for readmissions due to worsening of HF. Thereafter, the score was externally validated using a different cohort of 992 patients with chronic HF (MUSIC registry). Predictors of 1‐month readmission were the presence of elevated natriuretic peptides, left ventricular (LV) HF signs, and estimated glomerular filtration rate (eGFR) <60 mL/min/m2. Predictors of 1‐year readmission were elevated natriuretic peptides, anaemia, left atrial size >26 mm/m2, heart rate >70 b.p.m., LV HF signs, and eGFR <60 mL/min/m2. The C‐statistics for the models were 0.72 and 0.66, respectively. The cumulative incidence function distinguished low‐risk (<1% event rate) and high‐risk groups (>5% event rate) for 1‐month HF readmission. Likewise, low‐risk (7.8%), intermediate‐risk (15.6%) and high‐risk groups (26.1%) were identified for 1‐year HF readmission risk. The C‐statistics remained consistent after the external validation (<5% loss of discrimination).ConclusionThe Redin‐SCORE predicts early and late readmission for worsening of HF using proven prognostic variables that are routinely collected in outpatient management of chronic HF.

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“…In HF patients, only 1 study reported the risk of cardiac death associated with RBBB . The HR was 1.89 (95% CI: 1.19–3.01).…”

Section: Resultsmentioning

confidence: 99%

“…However, the Copenhagen City Heart Study of 18 441 participants without prior myocardial infarction (MI) or heart failure (HF) revealed that RBBB increased the risk for all‐cause mortality and cardiac death over 20 years of follow‐up . Furthermore, in patients with heart disease (MI and HF), several other studies have reported positive associations between RBBB and all‐cause mortality, whereas others have reported no association …”

Section: Introductionmentioning

confidence: 99%

The Prognostic Significance of Right Bundle Branch Block: A Meta‐analysis of Prospective Cohort Studies

Xiong

Wang

Liu

et al. 2015

Clinical Cardiology

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Background: The prognostic significance of right bundle branch block (RBBB) is inconsistent across studies. We aimed to assess the association between RBBB (in general population and patients with heart disease) and risk of all-cause mortality, cardiac death, acute myocardial infarction (MI), and heart failure (HF). Hypothesis: RBBB may be associated with increased risk of death. Methods: PubMed, EMBASE, and the Cochrane Library up to February 2015 were searched for prospective cohort studies that reported RBBB at baseline and all-cause mortality, cardiac death, MI, and HF at follow-up. A meta-analysis of published data was undertaken primarily by means of fixed-effects models. Results: Nineteen cohort studies including 201 437 participants were included with a mean follow-up period ranging from 1 to 246 months. For general population with RBBB, the pooled adjusted hazard ratio (HR) for all-cause mortality was 1.17 (95% confidence interval [CI]: 1.03-1.33) compared with no BBB. General population with RBBB had an increased risk of cardiac death (HR: 1.43, 95% CI: 1.17-1.74). For patients with RBBB and acute MI, the pooled risk ratio was 2.31 (95% CI: 2.13-2.49) for in-hospital mortality, 2.85 (95% CI: 2.46-3.30) for 30-day mortality, and 1.96 (95% CI: 1.59-2.42) for longer-term mortality. For acute HF patients, the pooled risk ratio of all-cause mortality was 1.11 (95% CI: 1.06-1.16), and for chronic HF patients it was 1.75 (95% CI: 1.38-2.22). Conclusions: Right bundle branch block is associated with an increased risk of mortality in general population and patients with heart disease. IntroductionRight bundle branch block (RBBB) is an intraventricular conduction disorder in which normal electrical activity in the His-Purkinje system is disrupted and depolarization of the right ventricle is delayed. After the left ventricle depolarizes normally, the wave of depolarization spreads to the right ventricle through nonspecialized conducting tissue. Consequently, the electrocardiogram (ECG) reveals a QRS duration ≥0.12 seconds, a secondary R wave (R ) in V 1 or V 2 , and a wide slurred S wave in leads I, V 5 , and V 6 , often with associated ST-segment depression and T-wave inversion in the right precordial leads.

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Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure

Cited by 28 publications

References 31 publications

Ventricular conduction abnormalities as predictors of long‐term survival in acute de novo and decompensated chronic heart failure

Ventricular conduction abnormalities as predictors of long‐term survival in acute de novo and decompensated chronic heart failure

A simple validated method for predicting the risk of hospitalization for worsening of heart failure in ambulatory patients: the Redin‐SCORE

The Prognostic Significance of Right Bundle Branch Block: A Meta‐analysis of Prospective Cohort Studies

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