Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: The Health 2000 Survey

Haataja, Paula; Nikus, Kjell; Kähönen, Mika; Huhtala, Heini; Nieminen, Tuomo; Jula, Antti; Reunanen, Antti; Salomaa, Veikko; Sclarovsky, Samuel; Nieminen, Markku S.; Eskola, Markku

doi:10.1016/j.ijcard.2012.05.024

Cited by 38 publications

(58 citation statements)

References 24 publications

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“…2–4 RBBB has not been found to predict incident HF. 5–7 In a report from the Heart Outcomes Prevention Evaluation (HOPE) trial, baseline LBBB was an independent predictor of HF, sudden death, CVD death, and all cause death, but baseline RBBB was not associated with increased CVD risk.…”

Section: Discussionmentioning

confidence: 91%

Different Patterns of Bundle-Branch Blocks and the Risk of Incident Heart Failure in the Women’s Health Initiative (WHI) Study

Zhang

Rautaharju

Soliman

et al. 2013

Circ: Heart Failure

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H eart failure (HF) as a consequence of ischemic, hypertensive, or valvular heart disease is known to be more common in bundle-branch blocks (BBBs) than in normal ventricular conduction. Left BBB (LBBB) has been associated with excess risk of incident HF in some studies, 1-4 but right BBB (RBBB) has not been found to predict incident HF. [5][6][7] Overall, available data are limited about specific BBB categories as predictors of incident HF, particularly in women. Therefore, the aim of the present study was to evaluate independent prognostic significance of BBBs in predicting incident HF, and further to evaluate whether repolarization abnormalities associated with BBBs contain additional prognostic information. Clinical Perspective on p 661 Methods Study Population and DesignThe Women's Health Initiative (WHI) study is a multicenter investigation of risk factors for the prevention of common causes of mortality, morbidity, and impaired quality of life in United States-postmenopausal women. Detailed eligibility criteria and recruitment methods, randomization, follow-up, data and safety monitoring, and quality assurance have been published previously. [8][9][10] The study was approved by the Institutional Review Board of each study site. All participants provided written informed consent. Of the 68 133 WHI clinical trial participants who were enrolled from 1993 to 1998, we excluded 2158 participants from analyses: 960 participants with no ECG data, 614 with inadequate quality ECG, 109 with an external pacemaker or Wolff-ParkinsonWhite pattern, and 475 participants with prevalent HF (self-report) at baseline. In the remaining group of 65 975 participants, 1676 had BBBs, and 64 299 had no BBBs (Figure). Background-We evaluated the risk of incident heart failure (HF) associated with bundle-branch blocks (BBBs) in postmenopausal women. Methods and Results-Cox's regression was used to evaluate hazard ratios with 95% confidence intervals for HF among 65 975 participants of the Women's Health Initiative (WHI) study during an average follow-up of 14 years. BBBs observed in 1676 women at baseline were categorized into left, right, and indetermined-type BBBs (LBBB, RBBB, and intraventricular conduction defect, respectively). Compared with women with no BBB, LBBB, and intraventricular conduction defect were strong predictors of incident HF in multivariable-adjusted risk models (hazard ratio, 3.79; confidence interval, 2.95-4.87 for LBBB and hazard ratio, 3.53; confidence interval, 2.14-5.81 for intraventricular conduction defect). RBBB was not a significant predictor of incident HF in multivariable-adjusted risk model, but the combination of RBBB and left anterior fascicular block was a strong predictor (hazard ratio, 2.96; confidence interval, 1.77-4.93). QRS duration was an independent predictor of incident HF only in LBBB, with more pronounced risk at QRS ≥140 ms than at <140 ms. QRS nondipolar voltage (RNDPV) was an independent predictor in both RBBB and LBBB and, in addition, in LBBB, QRS/STT angle and ST J-point depress...

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Section: Discussionmentioning

confidence: 91%

Different Patterns of Bundle-Branch Blocks and the Risk of Incident Heart Failure in the Women’s Health Initiative (WHI) Study

Zhang

Rautaharju

Soliman

et al. 2013

Circ: Heart Failure

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“…24–26 These studies have in general found that the risk for RBBB is not significant or only marginally significant. 13,27–28 It has been suggested that the QRS/T angle should be a part of the ECG evaluation of the patient with HF.…”

Section: Discussionmentioning

confidence: 98%

Usefulness of Electrocardiographic QRS/T Angles With Versus Without Bundle Branch Blocks to Predict Heart Failure (from the Atherosclerosis Risk in Communities Study)

Zhang

Rautaharju

Prineas

et al. 2014

The American Journal of Cardiology

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Repolarization abnormalities in the setting of bundle branch blocks (BBB) are generally ignored. We used Cox regression models to determine hazard ratios (HR) with 95% confidence intervals (CI) for incident heart failure (HF) associated with wide spatial and frontal QRS/T angle (upper 25th percentile of each) in men and women with and without BBB. This analysis included 14,478 participants (54.6% women, 26.4% blacks, 377 (2.6%) with BBB) from the Atherosclerosis Risk in Communities Study who were free of HF at baseline. Using No-BBB with normal spatial QRS/T angle as the reference group, the risk for HF in multivariable adjusted models was increased 51% for No-BBB with wide spatial QRS/T angle (HR 1.51, CI 1.37–1.66), 48% for BBB with normal spatial QRS/T angle (HR 1.48, CI 1.17–1.88), and the risk for incident HF was increased over 3-fold for BBB with wide spatial QRS/T angle (HR 3.37, CI 2.47–4.60). The results were consistent across subgroups by sex. Similar results were observed for the frontal plane QRS/T angle. In the pooled BBB group excluding RBBB, a positive T wave in lead aVR and heart rate 70 bpm and higher were also potent predictors of incident HF similar to the QRS/T angles. In conclusion, both BBB and wide QRS/T angles are predictive of heart failure, and concomitant presence of both carries a much higher risk than for either predictor alone. These findings suggest that repolarization abnormalities in the setting of BBB should not be considered benign or an expected consequence of BBB.

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“…5–7 In a report from the Heart Outcomes Prevention Evaluation (HOPE) trial, 3 baseline LBBB was an independent predictor of HF, sudden death, CVD death, and all cause death, but baseline RBBB was not associated with increased CVD risk. Zhang 5 et al evaluated the risk of incident HF for BBBs with over 14 years of follow-up for 65,975 participants in the Women’s Health Initiative study, and found that LBBB, IVCD, and RBBB combined with LAFB were strong predictors of incident HF in multivariable adjusted risk models, but RBBB was not a significant predictor.…”

Section: Discussionmentioning

confidence: 99%

Ventricular Conduction Defects and the Risk of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study

Zhang¹,

Rautaharju²,

Prineas³

et al. 2015

Journal of Cardiac Failure

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Background We evaluated the risk of incident heart failure (HF) associated with various categories of ventricular conduction defects (VCD) and examined the impact of QRS duration on the risk of HF. Methods and Results This analysis included 14,478 participants from the Atherosclerosis Risk in Communities (ARIC) study who were free of HF at baseline. VCDs (n=377) were categorized into right and left bundle branch blocks (RBBB and LBBB, respectively), bifascicular BBB (RBBB with fascicular block), indetermined type VCD (IVCD), and pooled-VCD group excluding lone RBBB. During an average of 18 years follow-up, 1,772 participants were hospitalized for incident HF. Compared to No-VCD, LBBB and pooled-VCD were strongly associated with increased risk of incident HF (multivariable hazard ratio 2.87 and 2.29, respectively). Compared to No-VCD with QRS duration <100 ms, HF risk was 1.17-fold for the No-VCD group with QRS duration 100–119 ms, 1.97-fold for pooled-VCD group with QRS duration 120–139 ms and 3.25-fold with QRS duration ≥140 ms. HF risk for pooled VCD group remained significant (1.74-fold for QRS duration 120–139 ms and 2.81-fold for QRS duration 140 ms or longer) in the subgroup free from cardiovascular disease at baseline. Lone RBBB was not associated with incident HF. Conclusions VCDs except for isolated RBBB are strong predictors of incident HF, and HF risk is further increased as the QRS duration is prolonged above 140 ms.

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Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: The Health 2000 Survey

Cited by 38 publications

References 24 publications

Different Patterns of Bundle-Branch Blocks and the Risk of Incident Heart Failure in the Women’s Health Initiative (WHI) Study

Different Patterns of Bundle-Branch Blocks and the Risk of Incident Heart Failure in the Women’s Health Initiative (WHI) Study

Usefulness of Electrocardiographic QRS/T Angles With Versus Without Bundle Branch Blocks to Predict Heart Failure (from the Atherosclerosis Risk in Communities Study)

Ventricular Conduction Defects and the Risk of Incident Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study

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