Prognostic Implication of Ventricular Conduction Disturbance Pattern in Hospitalized Patients with Acute Heart Failure Syndrome

Abstract

Background and Objectives Conflicting data exist regarding the prognostic implication of ventricular conduction disturbance pattern in patients with heart failure (HF). This study investigated the prognostic impact of ventricular conduction pattern in hospitalized patients with acute HF. Methods Data from the Korean Acute Heart Failure registry were used. Patients were categorized into four groups: narrow QRS (<120 ms), right bundle branch block (RBBB), left bundle branch block (LBBB), and nonspecific intraventricular conduction delay (NICD). The NICD was defined as prolonged QRS (≥120 ms) without typical features of LBBB or RBBB. The primary endpoint was the composite of all-cause mortality or rehospitalization for HF aggravation within 1 year after discharge. Results This study included 5,157 patients. The primary endpoint occurred in 39.7% of study population. The LBBB group showed the highest incidence of primary endpoint followed by NICD, RBBB, and narrow QRS groups (52.5% vs. 49.7% vs. 44.4% vs. 37.5%, p<0.001). In a multivariable Cox-proportional hazards regression analysis, LBBB and NICD were associated with 39% and 28% increased risk for primary endpoint (LBBB hazard ratio [HR], 1.392; 95% confidence interval [CI], 1.152–1.681; NICD HR, 1.278; 95% CI, 1.074–1.520) compared with narrow QRS group. The HR of RBBB for the primary endpoint was 1.103 (95% CI, 0.915–1.329). Conclusions LBBB and NICD were independently associated with an increased risk of 1-year adverse event in hospitalized patients with HF, whereas the prognostic impacts of RBBB were limited. Trial Registration ClinicalTrials.gov Identifier: NCT01389843

Ventricular Conduction Disturbance in Acute Heart Failure Syndrome: Does It Matter for Prognosis?

“…Tolppanen et al8) followed up 982 patients with HF for 3.9 years and revealed that only presence of RBBB and NICD (QRS ≥110 ms) were associated with 1.7-fold and 1.6-fold increased risks of mortality respectively. Since the definition of NICD (QRS ≥110 ms) is different from that in Lee et al's study6) (QRS ≥120 ms), these results cannot be directly compared with present study. Even though they suggest that ventricular conduction disturbance especially NICD was associated with mortality in AHF patients, the pathophysiology and the mechanism of NICD has not been clearly understood yet.…”

“…In this issue of the journal, Lee et al6) analyzed data from the Korean Acute Heart Failure registry and investigated prognostic impact of NICD and compared 1-year all-cause mortality of patient with NICD to those of patients with RBBB, LBBB, and normal QRS duration. Authors suggest that NICD was associated with an increased risk of 1-year mortality, whereas the prognostic impacts of LBBB/RBBB was limited compared to previous studies.…”

Deep learning of ECG waveforms for diagnosis of heart failure with a reduced left ventricular ejection fraction

“…The DeepECG-HFrEF (+) group had significantly increased corrected QT intervals and increased proportions of LBBB and IVCD. A study by Lee et al showed that LBBB and IVCD were associated with an increased risk of all-cause mortality and rehospitalization due to HF aggravation 24 . Regarding the QTc interval, a study by Park et al showed a J-curve association between the corrected QT interval and mortality among patients with acute HF, with a nadir of 440–450 ms in men and 470–480 ms in women 25 .…”

Deep Learning of ECG Waveforms for Diagnosis of Heart Failure With a Reduced Left Ventricular Ejection Fraction

“…The DeepECG-HFrEF (+) group had signi cantly increased corrected QT intervals and increased proportions of LBBB and IVCD. A study by Lee et al showed that LBBB and IVCD were associated with an increased risk of all-cause mortality and rehospitalization due to HF aggravation 24 . Regarding the QTc interval, a study by Park et al showed a J-curve association between the corrected QT interval and mortality among patients with acute HF, with a nadir of 440-450 ms in men and 470-480 ms in women 25 .…”