Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing

Hesse, B; Diaz, Lazaro A; Snader, Claire E; Blackstone, Eugene H.; Lauer, Michael S.

doi:10.1016/s0002-9343(00)00713-0

Cited by 148 publications

(60 citation statements)

References 38 publications

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“…Rhythm, rate, and axis and conduction system abnormalities were recorded and analyzed. Left bundlebranch block (LBBB) was defined as QRS duration ≥ 120 ms or more, notched r waves in V 5 and V 6 , absence of Q waves in V 5 and V 6 , and delay of the intrinsicoid deflection in V 5 and V 6 . Right bundle-branch block (RBBB) was defined as prolonged QRS > 120 ms, presence of rsR' or rSR', delay in the intrinsicoid deflection in the right precordial leads, and a wide S wave in I, V 5 , and V 6 .…”

Section: Methodsmentioning

confidence: 99%

Electrocardiogram and clinical characteristics of patients referred for cardiac transplantation: Implications for pacing in heart failure

Freudenberger

Sikora

Fisher

et al. 2004

Clinical Cardiology

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SummaryBackground: Permanent pacing for the treatment of heart failure (HF) has been the subject of intense research over the past decade. Those with conduction abnormalities may benefit most from pacing. The incidence of these conduction abnormalities in patients referred for cardiac transplantation and its relationship to outcome has not been well described.Hypothesis: This study sought to determine the incidence of these abnormalities and to correlate these findings to outcome in this patient population.Methods: A review of 100 patients referred for transplantation was performed. Data were analyzed in two groups: those with QRS duration < 120 ms and those with a QRS duration > 120 ms. Times to transplantation or death were analyzed in these two groups.Results: Of these patients, 34% had QRS duration ≥ 120 ms and survival was inversely associated with QRS duration. Of those with QRS duration < 120 ms, 24% (16) went on to cardiac transplantation or died. Of those with a QRS duration ≥ 120 ms, 55% (17) went on to transplantation or died (p = 0.0134).Conclusions: This suggests that in addition to a multi-drug regimen for heart failure, 34% of patients referred for transplantation may benefit from additional therapy with biventricular pacing.

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Section: Methodsmentioning

confidence: 99%

Electrocardiogram and clinical characteristics of patients referred for cardiac transplantation: Implications for pacing in heart failure

Freudenberger

Sikora

Fisher

et al. 2004

Clinical Cardiology

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“…Kairiosios Hiso pluošto kojytės blokada (KHPKB) yra susijusi su didesne širdies ir kraujagyslių ligų komplikacijų rizika, ypač pacientams, sergantiems išemine širdies liga (1)(2)(3). Todėl išeminės širdies ligos nustatymas pacientams, turintiems šį laidumo sutrikimą, padeda pasirinkti gydymo taktiką.…”

Section: įVadasunclassified

Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion

Aleksynas

Kaupas²,

Antuševas³

2009

Medicina

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77,8 proc., specifiškumas -92,3 proc., teigiama prognostinė vertė -70 proc., neigiama prognostinė vertė -94,7 proc. Palyginus kiekvieno paciento tyrimų duomenis, kompiuterinės tomografijos jautrumas buvo 81,8 proc., specifiškumas -84,6 proc., teigiama prognostinė vertė -81,8 proc., neigiama prognostinė vertė -84,6 proc. Išvados. Vainikinių arterijų angiografija, atlikta daugiapjūviu kompiuteriniu tomografu, pasižymi aukštu diagnostiniu tikslumu nustatant hemodinamiškai reikšmingas stenozes esant kairiosios Hiso pluošto kojytės blokadai.Adresas susirašinėti: A. Jankauskas, KMU Radiologijos klinika, Eivenių 2, 50009 Kaunas El. paštas: jankauskas.antanas@gmail.com ĮvadasKairiosios Hiso pluošto kojytės blokada (KHPKB) yra susijusi su didesne širdies ir kraujagyslių ligų komplikacijų rizika, ypač pacientams, sergantiems išemine širdies liga (1-3). Todėl išeminės širdies ligos nustatymas pacientams, turintiems šį laidumo sutrikimą, padeda pasirinkti gydymo taktiką. Tačiau KHPKB, sąlygojanti nesinchronišką skilvelių kontrakciją ir relaksaciją, sunkina išeminės širdies ligos diagnostiką įprastiniais neinvaziniais tyrimo metodais (krūvio EKG, echokardioskopija) (4, 5). Krūvio radionuklidinės kompiuterinės tomografijos metu anteroseptalinėje srityje dažnai registruojami grįžtami perfuzijos defektai, kurių priežastis gali būti ne arterijos spindžio susiaurėjimas, o nesinchroniškos skilvelių veiklos sąlygotas miokardo mikrocirkuliacijos pablogėjimas (6, 7). Diagnozei patikslinti šiems pacientams dažnai tenka atlikti intervencinę vainikinių arterijų angiografiją. Todėl daugiapjūvės kompiuterinės tomografijos (DKT) tyrimas pastaruoju metu pradėtas taikyti ateroskleroziniams pokyčiams vainikinėse arterijose vizualizuoti, gali būti vertingas neinvazyvus diagnostikos metodas esant šio tipo laidumo sutrikimui (8).DKT aparatai sparčiai tobulinami, tačiau tiek 16 detektorių, tiek naujesnės kartos 64 detektorių aparatais atliktuose tyrimuose išlieka artefaktų, sąlygotų vainikinių arterijų judesio ar stambių kalcifikatų tikiMedicina (Kaunas) 2009; 45(4) KLINIKINIAI TYRIMAI

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“…6 However, the majority of CRT recipients reported in previous studies have had LBBB QRS morphology, [1][2][3] and therefore the electrophysiological and mechanical rationale for using CRT in such patients has been well characterized. [18][19][20] In contrast there is little data for patients who present with nonspecific conduction delays or RBBB.…”

Section: Qrs Width Crbbb LV Dyssynchrony and Crtmentioning

confidence: 99%

“…2,5 Recently, RBBB was proven to be an important predictor of mortality in patients with congestive HF, just as has LBBB. 6 However, patients with RBBB and congestive HF have not been adequately evaluated because of an under-representation in the referenced studies. Therefore, which type of patients with RBBB has ventricular conduction delays, and thus are good candidates for CRT, has not been fully clarified.…”

mentioning

confidence: 99%

Right Bundle Branch Block and Impaired Left Ventricular Function as Evidence of a Left Ventricular Conduction Delay

Takamatsu

Tada

Okaniwa

et al. 2008

Circ J

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ardiac resynchronization therapy (CRT) in patients with advanced heart failure (HF) and a ventricular conduction delay improves symptoms and functional capacity, induces reverse remodeling, and reduces morbidity, and probably mortality. [1][2][3][4] It is well known that although the vast majority of CRT recipients present with left bundle branch block (LBBB), up to 10% of the minority have nonspecific conduction delays or right bundle branch block (RBBB). 2,5 Recently, RBBB was proven to be an important predictor of mortality in patients with congestive HF, just as has LBBB. 6 However, patients with RBBB and congestive HF have not been adequately evaluated because of an under-representation in the referenced studies. Therefore, which type of patients with RBBB has ventricular conduction delays, and thus are good candidates for CRT, has not been fully clarified. Methods Study PopulationThis study included 104 patients (34 women, 70 men; mean age, 59±15 years) who underwent conventional echocardiography, including tissue Doppler imaging (TDI) and tissue tracking imaging (TTI) between January 2002 and December 2004. Of these, 49 consecutive patients had complete RBBB (CRBBB) with a duration of the QRS complex of ≥120 ms (RBBB-Gr). The remaining 55 had normal morphology of the QRS complex and narrow QRS (<120 ms; Control-Gr), and were randomly selected so that the data collected would be statistically matched to the RBBB-Gr patients in terms of age and gender (Table 1). In total, 33 patients had hypertension, 5 dilated cardiomyopathy, 5 mitral valvular diseases, 2 hypertrophic cardiomyopathy, 1 congenital heart disease, 3 ischemic heart disease, and the remaining 93 (89%) had no structural heart disease. Echocardiography demonstrated that the mean left ventricular ejection fraction (LVEF) was 64.2±11.8% (range, 12-83), and left ventricular end-diastolic diameter (LVEDD) 46.5± 8.5 mm (range, 34-75). All patients were in sinus rhythm, and the mean QRS duration was 113.8±33.3 ms (range, 70-200). All patients in the Control-Gr had LVEF >50% (range, 51-83). Echocardiographic Examination Including TDI and TTIThe left ventricular (LV) dimensions were measured by M-mode echocardiography in the parasternal long-axis view. The LVEDD was measured at the onset of the QRS Background The indications and efficacy of cardiac resynchronization therapy (CRT) have not been sufficiently clarified in patients with right bundle branch block (RBBB). Methods and ResultsThis study included 55 patients with normal QRS morphology and duration (ControlGr) and 49 patients with complete RBBB (CRBBB-Gr). Using tissue Doppler imaging, the time difference (TD) between the electromechanical delay of the septal wall, left ventricular (LV) lateral wall, and right ventricular free wall were measured. Using tissue tracking imaging, the coefficient of the time variation from the beginning of the QRS to the peak displacement time of 6 regions of the LV (CV-PMDLV) was calculated. The TD between the septal wall and that of the LV lateral wall (TDSEPT-LAT)...

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Complete bundle branch block as an independent predictor of all-cause mortality: report of 7,073 patients referred for nuclear exercise testing

Cited by 148 publications

References 38 publications

Electrocardiogram and clinical characteristics of patients referred for cardiac transplantation: Implications for pacing in heart failure

Electrocardiogram and clinical characteristics of patients referred for cardiac transplantation: Implications for pacing in heart failure

Subintimal angioplasty: an alternative to open surgery of the lower limb chronic artery occlusion

Right Bundle Branch Block and Impaired Left Ventricular Function as Evidence of a Left Ventricular Conduction Delay

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