Discordant vs. concordant left bundle branch block: A potential clinical significance

Jalkh, Khalil; Bernard, Abi Saleh; Khoury, Maurice; Yousef, Zaheer; Refaat, Marwan M.; Abdallah, R.El-Fassi-Ben; Alam, Samir; Skouri, Hadi

doi:10.1016/j.jelectrocard.2015.08.031

Cited by 6 publications

(13 citation statements)

References 37 publications

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“…A cross sectional study of LBBB patient showed that discordant LBBB was associated with more severe HF when compared to patients with concordant LBBB. [14] These findings are further supported by patient characteristics in studies of HF patients with discordant LBBB. [9,13] In our study we observed an increased short-term risk of HF development when comparing discordant to concordant LBBB.…”

Section: Accepted Manuscript 10mentioning

confidence: 63%

“…V5 or V6. [9,13,14] Additionally, the frontal plan QRS-T angle was calculated as the absolute difference between the frontal plane QRS axis and frontal plane T axis and patients were divided in four groups using the quartiles of the difference in angle.…”

Section: Exposurementioning

confidence: 99%

“…The prevalence of discordant LBBB in our population was lower (39%) compared to previous studies (62-72 %). [9,13,14] A likely explanation is that we selected primary care patients without known HF in contrast to previous studies including hospitalized patient with HF.…”

Section: Accepted Manuscript 10mentioning

confidence: 99%

“…[11,12] However, recent evidence suggests that discordant LBBB is a marker of poor prognosis in HF patients with LBBB [9,13] and may be associated with worse systolic function. [9,10,[13][14][15] LBBB is often associated with cardiac disease, but may also be observed in apparently healthy people. Twave discordance in LBBB could be a sign of underlying or developing HF, but this has not yet been studied.…”

Section: Introductionmentioning

confidence: 99%

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Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study

Riis

Kragholm

Mortensen

et al. 2019

Journal of Electrocardiology

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Background: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. Methods: Between 2001-2011, we identified 2,540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. Results: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1,627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval[CI] 1.71-3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19-1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26-4.02) within 30 days and a HR of 1.67 (95%CI 1.25-2.23) after 30 days. Conclusion: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.

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Section: Accepted Manuscript 10mentioning

confidence: 63%

Section: Exposurementioning

confidence: 99%

Section: Accepted Manuscript 10mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study

Riis

Kragholm

Mortensen

et al. 2019

Journal of Electrocardiology

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“…ECG tracings (25 mm/s; 10 mm/1 mV) showing complete left bundle branch block (cLBBB), characterized by a positive T wave in leads I, aVL, V 5 , and V 6 (a); and dLBBB, characterized by ST-segment depression followed by a negative asymmetric T wave in at least two of the lateral leads (b). LBBB: left bundle branch block Compared with concordant LBBB, discordant LBBB morphology was associated with more severe coronary artery disease (Khalil et al, 2016) and heart failure and worse prognosis, even in patients receiving a CRT with defibrillator capacity (Padeletti et al, 2018).…”

Section: The Prog Nos Is In Clb B Bmentioning

confidence: 99%

Re‐evaluating the electro‐vectorcardiographic criteria for left bundle branch block

Pérez‐Riera

Barbosa‐Barros

Daminello‐Raimundo

et al. 2019

Noninvasive Electrocardiol

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The criteria for left bundle branch block have gained growing interest in the last few years. In this overview, we discuss diagnostic and prognostic aspects of different criteria. It was already shown that stricter criteria, including longer QRS duration and slurring/notching of the QRS, better identify responders to cardiac resynchronization therapy. We also include aspects of ST/T concordance and discordance and vectorcardiography, which could further improve in the fine-tuning of the left bundle branch criteria.

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Outcomes with T‐wave discordance of left bundle branch block and preserved or mildly reduced ejection fraction

Huang,

Chien,

Liu

2024

ESC Heart Failure

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AimsLeft bundle branch block (LBBB) is associated with an increased risk of adverse outcomes for patients with heart failure. The prognosis of LBBB in patients with a preserved ejection fraction (EF) remains controversial. This study investigated the predictive value of T‐wave discordance for the prognosis of patients with LBBB and preserved or mildly reduced EF.Methods and resultsWe enrolled 707 patients with complete LBBB and left ventricular (LV) EF ≥ 40% observed using electrocardiograms (ECGs) and echocardiograms between January 2010 and December 2018. Their serial ECGs were reviewed during the follow‐up period. The T‐wave pattern was classified as discordant LBBB (dLBBB) or concordant LBBB (cLBBB) according to the 12‐lead ECG T‐wave morphology. The primary outcome was the composite of cardiovascular death or hospitalization for heart failure during a median follow‐up period of 3.1 years. A multivariable Cox regression analysis was used to evaluate the independent predictors of the primary outcome. Patients with dLBBB had more comorbidities, a higher heart rate, a longer QRS and QTc duration, a larger LV end‐systolic volume and left atrial dimension, a lower LVEF, and a higher mitral E/A ratio and E/e′, compared with those with cLBBB. Older age [hazard ratio (HR) = 1.023, 95% confidence interval (CI) = 1.001–1.046, P = 0.023], history of heart failure (HR = 2.440, 95% CI = 1.524–3.905, P = 0.001), chronic kidney disease (HR = 1.917, 95% CI = 1.182–3.110, P = 0.008), larger LV end‐systolic volume (HR = 1.046, 95% CI = 1.017–1.075, P = 0.002), lower LVEF (HR = 0.916, 95% CI = 0.885–0.948, P = 0.001), and presence of dLBBB (HR = 1.63, 95% CI = 1.011–2.628, P = 0.032) were independent predictors of the primary outcome in patients with LBBB and LVEF ≥ 40%. The discordant or concordant T‐wave morphology of LBBB could transform from one subtype to the other in up to 23% of the study population during the follow‐up period, and individuals with persistent or transformed dLBBB faced an increased risk of cardiovascular death or non‐fatal heart failure hospitalization.ConclusionsIn patients with LBBB and EF ≥ 40%, dLBBB serves as an independent predictor of a higher risk of cardiovascular death or non‐fatal heart failure hospitalization.

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Discordant vs. concordant left bundle branch block: A potential clinical significance

Cited by 6 publications

References 37 publications

Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study

Association between T-wave discordance and the development of heart failure in left bundle branch block patients: Results from the Copenhagen ECG study

Re‐evaluating the electro‐vectorcardiographic criteria for left bundle branch block

Outcomes with T‐wave discordance of left bundle branch block and preserved or mildly reduced ejection fraction

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