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Prognostic implications of intraventricular conduction defects in patients undergoing stress echocardiography for
Lauro Cortigiani1, Riccardo Bigi, Guido Gigli
1Division of Cardiology, Lucca Hospital, Lucca, Italy. lacortig@tin.it
Insights
Right bundle branch block with left anterior hemiblock predicts mortality in patients undergoing stress echocardiography. Isolated right bundle branch block does not significantly impact outcomes, similar to patients without conduction defects.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Electrophysiology
Background:
- Conduction defects on resting electrocardiograms can indicate underlying cardiac issues.
- Stress echocardiography is a key diagnostic tool for evaluating suspected coronary artery disease.
- The prognostic significance of various intraventricular conduction defects (IVCDs) in this context requires further clarification.
Purpose of the Study:
- To determine the prognostic value of IVCDs in patients without known coronary artery disease referred for stress echocardiography.
- To identify specific IVCD patterns associated with increased mortality risk.
Main Methods:
- A cohort of 1230 patients (mean age 63 years) underwent stress echocardiography (dipyridamole or dobutamine).
- Resting electrocardiograms were analyzed for IVCDs; wall motion scores were calculated.
- Patients were followed for a mean of 41 months, with mortality as the primary endpoint.
Main Results:
- 34% of patients had IVCDs, including left bundle branch block, isolated right bundle branch block, and left anterior hemiblock.
- Right bundle branch block with left anterior hemiblock was an independent predictor of mortality (HR=3.7).
- Left bundle branch block, isolated right bundle branch block, and left anterior hemiblock were not associated with mortality in multivariate analyses.
Conclusions:
- Right bundle branch block with left anterior hemiblock is a significant independent predictor of mortality in patients undergoing stress echocardiography for suspected coronary artery disease.
- Isolated right bundle branch block appears to have a similar prognosis to patients without conduction defects in this population.
Purpose:
To investigate the prognostic implications of conduction defects in subjects without proven coronary artery disease who had been referred for stress echocardiography.
Methods:
The study sample consisted of 1230 patients (574 men and 656 women; mean [+/- SD] age, 63 +/- 10 years) who underwent stress echocardiography with dipyridamole (n = 780) or dobutamine (n = 450) to evaluate suspected coronary artery disease. A summary wall motion score (on a 1 to 4 scale) was calculated. Patients were followed for a mean of 41 +/- 27 months; mortality was the only endpoint.
Results:
Four hundred and twenty patients (34%) had intraventricular conduction defects on a resting electrocardiogram (173 with complete left bundle branch block, 98 with isolated right bundle branch block, 43 with right bundle branch block with left anterior hemiblock, and 106 with left anterior hemiblock). Ischemia at stress echo (new or worsening of preexisting wall motion abnormality) was found in 250 patients (20%). There were 56 deaths during follow-up; 138 patients underwent revascularization and were censored. Multivariate predictors of mortality were resting wall motion score index (hazard ratio [HR] = 6.0 per unit increase; 95% confidence interval [CI]: 2.3 to 16; P <0.0001), ischemia at stress echo (HR = 3.9; 95% CI: 2.2 to 6.7; P <0.0001), age >65 years (HR = 3.2; 95% CI: 1.7 to 5.9; P <0.0001), hypertension (HR = 1.8; 95% CI: 1.1 to 3.2; P = 0.03), and right bundle branch block with left anterior hemiblock (HR = 3.7; 95% CI: 1.8 to 7.5; P <0.0001). The other three forms of intraventricular conduction defects (left bundle branch block, isolated complete right bundle branch block, and left anterior hemiblock) were not associated with mortality in multivariate analyses, or among the 980 patients who did not have ischemia.
Conclusion:
Right bundle branch block with left anterior hemiblock is an independent predictor of mortality in patients with suspected coronary artery disease undergoing stress echocardiography, whereas isolated right bundle branch block is associated with outcomes similar to those observed in patients with no conduction defects.
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