The Prognostic Significance of Bundle Branch Block in High‐Risk Chronic Stable Vascular Disease Patients: A Report from the HOPE Trial

Sumner, Glen; Salehian, Omid; Yi, Qilong; Healey, Jeff S.; Mathew, James; Almerri, Khalid; Al-Nemer, Khaled; Mann, Johannes F.E.; Dagenais, Gilles R.; Lonn, Eva

doi:10.1111/j.1540-8167.2009.01440.x

Cited by 37 publications

(17 citation statements)

References 24 publications

(23 reference statements)

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“…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. 3,7 …”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…[106] The presence of LBBB in patients with cardiovascular disease or diabetes marks an independent risk for the development of HF. [107] Additionally, patients with chronic HF as LBBB marks an increased mortality [108] and is one of the hallmarks for which ventricular resynchronization is based. Recently, data from the Women’s Health Initiative Study has revealed that LBBB with a QRS >140 ms is a strong independent predictor of incident HF.…”

Section: Targeting At-risk Phenotypesmentioning

confidence: 99%

Treatment Strategies for the Prevention of Heart Failure

Grodin

Tang

2013

Curr Heart Fail Rep

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With the astounding morbidity and mortality associated with heart failure (HF), preventive approaches have been explored. Controlling hypertension to prevent HF is well-established, especially with sodium restriction and thiazide-based antihypertensive therapies showing potential advantages. Control of dyslipidemia with aggressive statin therapy is particularly beneficial in preventing HF in the setting of acute coronary syndrome. The HOPE study also established the benefit of ACE inhibitors in the prevention of HF in high-risk subjects. Meanwhile old data supporting tight glycemic control in preventing HF have not been confirmed, suggesting the complexity of diabetic cardiomyopathy. Avoiding tobacco use and other known cardiotoxins are likely helpful. While there has been substantial development in identifying biomarkers predicting future development of HF, therapeutic interdiction guided by biomarker levels have yet to be established even though it offers hope in modulating the natural history of the development of HF in at risk individuals.

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“…Model membranes studies also demonstrated clearly the close relation between vitamin E family and cholesterol [22,23]. Appropriate medication together with close follow-up treatment success can be achieved in many patients with borderline or abnormal lipid profiles (low plasma levels of high-density lipoprotein and high plasma levels of low-density lipoprotein) [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. Vitamin E family is an important nutrient with both antioxidant and non-antioxidant properties [6,7,[38][39][40][41][42][43][44][45][46][47][48][49], even recent evidence suggests that they have vital roles in human life including cardioprotective, neuroprotective, anti-aging properties [38,[50][51][52][53][54][55][56][57][58].…”

Section: Vitamin E Family: Introduction To Biochem-istry and Health Bmentioning

confidence: 99%

Vitamin E in Oxidant Stress-Related Cardiovascular Pathologies: Focus on Experimental Studies

Turan

Vassort²

2011

CPD

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The scope of this review is to summarize the important roles of vitamin E family members as protective agents in cardiovascular pathologies of different types of disease states and particularly in diabetes, including some of our research results, to illustrate how this recent knowledge is helping to better understand the roles of the vitamin E family in biology, in animals and humans specifically. Cardiovascular disease, a general name for a wide variety of diseases, disorders and conditions, is caused by disorders of the heart and blood vessels. Cardiovascular disease is the world's largest killer, claiming 17.1 million lives a year. Cardiovascular complications result from multiple parameters including glucotoxicity, lipotoxicity, fibrosis. Obesity and diabetes mellitus are also often linked to cardiovascular disease. In fact, cardiovascular disease is the most life-threatening of the diabetic complications and diabetics are 2-to 4-fold more likely to die of cardiovascular-related causes than non-diabetics.In order to prevent the tendency of cardiovascular disease, primary prevention is needed by modifying risk factors. Several recent studies, besides earlier ones, have reported beneficial effects of therapy with antioxidant agents, including trace elements, vitamins (E and/or C), other antioxidants, against the cardiovascular dysfunction. Hence, the use of peroxisome proliferator-activated receptor-(PPAR ) agonists to reduce fatty acid oxidation, of trace elements such as selenium as antioxidant and other antioxidants such as vitamins E and C, contributes to the prevention of these dysfunctions. Moreover, therapy with antioxidants and the above vitamins to prevent or delay the onset and development of cardiovascular complications in diabetic patients and animal models has been investigated although these studies showed inconsistent results.

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The Prognostic Significance of Bundle Branch Block in High‐Risk Chronic Stable Vascular Disease Patients: A Report from the HOPE Trial

Abstract: In patients with stable chronic CV disease, LBBB but not RBBB is an independent predictor of heart failure, sudden death, CV death, and all-cause death.

Cited by 37 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

Treatment Strategies for the Prevention of Heart Failure

Vitamin E in Oxidant Stress-Related Cardiovascular Pathologies: Focus on Experimental Studies

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