Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Rankinen, Jani; Haataja, Paula; Lyytikäinen, Leo-Pekka; Huhtala, Heini; Lehtimäki, Terho; Kähönen, Mika; Eskola, Markku; Pérez‐Riera, Andrés Ricardo; Jula, Antti; Niiranen, Teemu J.; Nikus, Kjell; Hernesniemi, Jussi

doi:10.1016/j.ijcha.2020.100639

“…Only a few studies have focused on NICD, and its pathophysiology is complex and reflects intramyocardial conduction delay due to cardiomyopathy [19]. NICD is also related to increased long-term mortality and the future occurrence of atrial fibrillation and HF [19][20][21]. In patients with conduction disorders, patients with NICD had a similar incidence of HF hospitalization, CV mortality, and allcause mortality when compared to patients with LBBB.…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome

Lee

¹

,

Fang

²

,

Chen

³

et al. 2022

International Journal of Clinical Practice

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Objective. Conduction disorders with a widened QRS are associated with poor prognosis in patients with acute coronary syndrome (ACS). Conduction disorders include left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (NICD). Previous studies did not have conflicting results regarding the type of bundle branch block (BBB) with the worst prognosis, and few studies have focused on the prognosis of patients with NICD. Methods. Patients with ACS were enrolled between January 2005 and December 2019, and their medical history (International Classification of Diseases codes) was obtained from the Chang Gung Research Database. Age, sex, comorbidities, left ventricular ejection fraction (LVEF), and drug use were compared between the patients with and without conduction disorders. The following clinical outcomes were compared between patients with and without conduction disorders: heart failure (HF) hospitalization, cardiovascular (CV) mortality, and all-cause mortality. After propensity score matching, the Kaplan–Meier curve analysis for HF hospitalization, CV mortality, and all-cause mortality were compared among patients with LBBB, RBBB, and NICD. Results. This study enrolled a total of 33970 participants and involved 3392 and 30578 patients with and without conduction disorders, respectively. Older age and a higher prevalence of comorbidities were noted in patients with conduction disorders. Lower mean LVEF was exhibited in the patients with conduction disorders (with vs. without; 44.64 ± 20.73% vs. 49.85 ± 20.63%; p < 0.001 ). During the 3-year follow-up period, higher incidences of HF hospitalization (21.55% vs. 17.51%; p < 0.001 ), CV mortality (17.98% vs. 12.14%; p < 0.001 ), and all-cause mortality (38.86% vs. 31.15%; p < 0.001 ) were noted in the patients with conduction disorder. After ACS events, 10.0% of patients presented with conduction disorders, with LBBB in 3.3%, RBBB in 6.0%, and NICD in 0.7%. The lowest mean of LVEF was presented in the patients with NICD (LBBB vs. RBBB vs. NICD; 41.00 ± 19.47% vs. 47.73 ± 20.82% vs. 34.57 ± 20.02%; p < 0.001 ). Among the three groups, the highest incidence of HF hospitalization was noted in patients with LBBB after propensity score matching. The lowest incidence of CV and all-cause mortality was observed in patients with RBBB. After adjustment of age, gender, comorbidities, medication, and mean LVEF, those with LBBB had the highest hazard ratio for major adverse cardiovascular events (MACEs) of 1.113 ( p = 0.029 ; 95% CI = 1.013–1.266). Conclusions. In the ACS population, patients with conduction delay had a poor prognosis due to a higher prevalence of comorbidities and lower mean LVEF. Among the patients with LBBB, RBBB, and NICD, those with LBBB and NICD had a higher incidence of HF hospitalization, CV mortality, and all-cause mortality. Patients with NICD had the lowest mean LVEF compared to those with LBBB and RBBB. Patients with LBBB had a significantly highest HR of MACE.

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“…Further tests are conducted in the form of imaging techniques such as an electrocardiogram (ECG) or an echocardiogram (ECHO). These have been useful in the assessment of HF in patients [ 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. The gold-standard for detecting HF is through a simple blood test looking for NT-pro-brain natriuretic peptide (NT-proBNP) and its active form brain type natriuretic peptide (BNP).…”

Section: Introductionmentioning

confidence: 99%

Novel Oxidative Stress Biomarkers with Risk Prognosis Values in Heart Failure

Ng

¹

,

Ao

²

,

Yap

³

et al. 2023

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Oxidative stress (OS) is mediated by reactive oxygen species (ROS), which in cardiovascular and other disease states, damage DNA, lipids, proteins, other cellular and extra-cellular components. OS is both initiated by, and triggers inflammation, cardiomyocyte apoptosis, matrix remodeling, myocardial fibrosis, and neurohumoral activation. These have been linked to the development of heart failure (HF). Circulating biomarkers generated by OS offer potential utility in patient management and therapeutic targeting. Novel OS-related biomarkers such as NADPH oxidases (sNox2-dp, Nrf2), advanced glycation end-products (AGE), and myeloperoxidase (MPO), are signaling molecules reflecting pathobiological changes in HF. This review aims to evaluate current OS-related biomarkers and their associations with clinical outcomes and to highlight those with greatest promise in diagnosis, risk stratification and therapeutic targeting in HF.

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“…1,2 Left bundle branch block (LBBB) is the most pathogenic conduction disturbance because this condition can cause left ventricular dysfunction and even dilatation. [3][4][5][6] In contrast, isolated right bundle branch block (RBBB) is usually considered benign. [5][6][7] However, if RBBB is present with left anterior or posterior fascicular block (bifascicular block), the prognosis is poor.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6] In contrast, isolated right bundle branch block (RBBB) is usually considered benign. [5][6][7] However, if RBBB is present with left anterior or posterior fascicular block (bifascicular block), the prognosis is poor. 8 Published data also support the adverse influence of nonspecific IVCD (NS-IVCD).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Bundle branch block and nonspecific intraventricular conduction delay prevalence using Chinese nationwide survey data

Qiao

¹

,

Lin

²

,

Chen

³

et al. 2022

J Int Med Res

3

0

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Objective We aimed to determine the prevalence of and the factors associated with intraventricular conduction disturbance in the Chinese population. Methods Electrocardiographic data from 42,031 people were retrospectively analysed. The weighted prevalences of left bundle branch block (LBBB), right bundle branch block (RBBB), bifascicular block and nonspecific intraventricular conduction delay (NS-IVCD) were calculated. The independently associated factors were determined using logistic regression analysis. Results The weighted prevalence for Chinese people older than 45 years was 0.17% for LBBB, 2.16% for RBBB and 0.44% for NS-IVCD. The weighted prevalence for RBBB combined with left anterior fascicular block was 0.17%, and 0.05% for RBBB combined with left posterior fascicular block. There were significant differences in the weighted prevalences of RBBB and NS-IVCD between men and women. The weighted prevalence of LBBB and RBBB increased markedly with increasing age. Age and diabetes were independent factors associated with LBBB, compared with age and sex for RBBB and sex and coronary artery disease for NS-IVCD. Conclusions This study provided reliable data for the weighted prevalence of and factors associated with LBBB, RBBB and NS-IVCD in Chinese adults.

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Relation of intraventricular conduction delay to risk of new-onset heart failure and structural heart disease in the general population

Cited by 3 publications

References 37 publications

The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome

The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome

Novel Oxidative Stress Biomarkers with Risk Prognosis Values in Heart Failure

Bundle branch block and nonspecific intraventricular conduction delay prevalence using Chinese nationwide survey data

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