Prognostic Significance of Left Axis Deviation in Acute Heart Failure Patients with Left Bundle branch block: an Analysis from the Korean Acute Heart Failure (KorAHF) Registry

Choi, Ki Hong; Han, Seongwook; Lee, Ga Yeon; Choi, Jin Oh; Jeon, Eun Seok; Lee, Hae Young; Lee, Sang Eun; Kim, Jae Joong; Chae, Shung Chull; Baek, Sang Hong; Kang, Seok Min; Choi, Dong Ju; Yoo, Byung Su; Kim, Kye Hun; Cho, Myeong Chan; Park, Hyun-Young; Oh, Byung Hee

doi:10.4070/kcj.2018.0048

Cited by 4 publications

(6 citation statements)

References 28 publications

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“…We noted that left axis deviation and first‐degree AVB were the only two ECG markers associated with all‐cause mortality. Left axis deviation has been shown in both population‐based studies 23 and in acute HF 24 to be associated with all‐cause mortality. Certainly, its role in cohorts of patients who do not have echocardiographic evidence of any type of HF though they have symptoms suspicious of HF and raised NTproBNP, like our cohort, had not been previously studied.…”

Section: Resultsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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Aims Clinical outcomes for patients suspected of having heart failure (HF) who do not meet the diagnostic criteria of any type of HF by echocardiography remain unknown. The aim of this study was to investigate the clinical predictors of all-cause mortality in patients with suspected HF, a raised N-terminal pro-b-type natriuretic peptide (NTproBNP) and who do not meet the diagnostic criteria of any type of HF by echocardiography. Methods and results Relevant data were taken from the Sheffield HEArt Failure (SHEAF) registry (222349P4). The inclusion criteria were presence of symptoms raising suspicion of HF, NTproBNP > 400 pg/mL, and preserved left ventricular function. Exclusion criteria were any type of HF by echocardiography. The outcome was defined as all-cause mortality. Cox proportional-hazards regression model was used to investigate the association between the survival time of patients and clinical variables; 1031 patients were identified with NTproBNP > 400 pg/mL but who did not have echocardiographic evidence of HF. All-cause mortality was 21.5% (222 deaths) over the mean follow-up (FU) period of 6 ± 2 years. NTproBNP was similar in patients who were alive or dead (P = 0.96). However, age (HR 1, P < 0.01), chronic kidney disease (CKD, HR 1.2, P < 0.01), chronic pulmonary obstructive disease (COPD, HR 1.6, P < 0.01), dementia (HR 5.9, P < 0.01), male gender (HR 1.4, P < 0.01), first-degree atrioventricular block (HR 2.1, P < 0.01), left axis deviation (HR 1.6, P = 0.04), and diabetes (HR 1.4, P = 0.03) were associated with all-cause mortality. In multivariate regression, age, gender, CKD stage, COPD, and dementia were independently associated with mortality. In patients with NTproBNP > 627 pg/mL, NYHA class predicted death (II, 19.6%; III, 27.4%; IV, 66.7%; P < 0.01). Conclusions Patients with no HF on echocardiography but raised NTproBNP suffer excess mortality particularly in the presence of certain clinical variables. Age, male gender, worsening CKD stage, presence of COPD, and dementia are independently associated with all-cause mortality in these patients. An NTproBNP > 627 pg/mL coupled with NYHA class could identify patients at greatest risk of death.

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Section: Resultsmentioning

confidence: 99%

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

et al. 2020

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“…Several investigations have been conducted during the last 5 decades to assess the significance of left axis deviation (≤−30°) in LBBB patients with ischemic and nonischemic cardiomyopathy. Some studies have suggested that the presence of left axis deviation during LBBB is the reflect of greater myocardial scarring tissue 11–15 . Other studies have supported a purely electrophysiological explanation for the left axis deviation with no discernible associations of structural characteristics (cardiac size, left ventricular dimensions or mass) or cardiac anatomic position with the QRS axis 16–19 .…”

Section: Discussionmentioning

confidence: 99%

The QRS frontal plane axis changes during left bundle branch block after transcatheter aortic valve replacement

Yagel,

Belhassen,

Planer

et al. 2023

Pacing Clinical Electrophis

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Background and AimsLeft bundle branch block (LBBB) is common after transcatheter aortic valve replacement (TAVR) and associated with a left or normal QRS axis. We aim to assess the QRS frontal plane axis shift changes during LBBB after TAVR and determine if the risk of procedure‐related high degree atrioventricular block (AVB) is affected by QRS axis shift changes.Methods and ResultsIn a retrospective single‐center study of 720 consecutive patients who underwent TAVR, 141 (19.6%) with normal baseline QRS duration developed a new LBBB after TAVR and constituted the study group. Most patients (59.6%) were females and the mean age of the cohort was 81.2 ± 6 years.ResultsAs compared with the baseline QRS axis before TAVR, the occurrence of LBBB was associated with a leftward QRS axis shift (by 40 ± 28.3°) in 73% of the study patients and a rightward (by 18.6 ± 19.4°) or no change in QRS axis in 25.6% and 1.4% of the study patients, respectively. A left QRS axis (−30°) was observed in 14.9% and 38.3% of the study patients before and after TAVR, respectively. The group of patients exhibiting a rightward or no QRS axis shift had a greater incidence of high degree AVB than the group of patients exhibiting a leftward QRS axis shift (18.4% vs. 6.8%, p = .056).ConclusionAlthough post TAVR‐LBBB is associated with a leftward QRS axis shift in most patients, a non‐negligible proportion of patients (27%) exhibited a rightward or no QRS axis shift. The latter group tend to have a higher risk of developing high degree AVB.

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“… 39) Other key messages and publications from KorAHF registry were summarized in Table 1 . 27) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39) 40) 41) 42) 43) 44) 45) 46) 47) 48) 49) 50) 51) 52) 53) 54) 55) 56) 57) 58) 59) 60) …”

Section: The Korean Acute Heart Failure Registry: Filling Gaps Of The...unclassified

Paradigm Shifts of Heart Failure Therapy: Do We Need Another Paradigm?

Lee

2020

Int J Heart Fail

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Heart failure (HF) is a progressive condition with intermittent acute decompensation leading to poor prognosis despite established guideline-directed therapy. A paradigm of HF therapy has been shifted over last four decades. Until the early 1970s, HF was empirically managed, then was managed with the hemodynamic concept until the early 1980s. According to the results of large randomized clinical trials, HF therapy has been shifted to the neurohormonal paradigm since the late 1980s until recently. Korean Acute Heart Failure (KorAHF) registry is a multi-center registry that recruited a total of 5625 admitted patients with acute HF from 2011 to 2014 and followed until 2019. Through KorAHF registry, we could obtain invaluable information or messages in various fields such as epidemiology, clinical characteristics, and treatment of acute HF in Korea and also had opportunities to fill the gap between guidelinedirected care and real-world practice. Considering significant unmet needs in HF therapy even at this moment, we do need another paradigm shift for HF therapy, such as molecular and regenerative paradigm using gene, stem cells, mechanical support as well as novel pharmacological agents.

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Prognostic Significance of Left Axis Deviation in Acute Heart Failure Patients with Left Bundle branch block: an Analysis from the Korean Acute Heart Failure (KorAHF) Registry

Cited by 4 publications

References 28 publications

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

Clinical predictors of all‐cause mortality in patients presenting to specialist heart failure clinic with raised NT‐proBNP and no heart failure

The QRS frontal plane axis changes during left bundle branch block after transcatheter aortic valve replacement

Paradigm Shifts of Heart Failure Therapy: Do We Need Another Paradigm?

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