[Coronary disease and left branch block]
Muharem Merić1, Ejub Halilović, Fahir Baraković
1Klinika za kardiovaskularne bolesti UKC Tuzla, Trnovac.
Insights
Left bundle branch block (LBBB) complicates electrocardiographic diagnosis of coronary artery disease. This study analyzed LBBB and its subtypes, like anterior left hemiblock (LAH), in patients undergoing coronary angiography, revealing associations with coronary artery stenosis.
Area of Science:
- Cardiology
- Electrophysiology
- Diagnostic Imaging
Context:
- Left bundle branch block (LBBB) presents diagnostic challenges in identifying coronary artery disease (CAD).
- LBBB can manifest as complete LBBB, anterior left hemiblock (LAH), or posterior left hemiblock (LPH), often complicating electrocardiographic interpretation.
- Coronary artery disease is a primary cause of LBBB, followed by sclerodegenerative changes in the heart's conduction system.
Purpose:
- To investigate the prevalence and diagnostic implications of LBBB and its subtypes in patients with suspected coronary artery disease.
- To analyze the correlation between electrocardiographic findings of LBBB, LAH, and LPH with the severity and extent of coronary artery stenosis.
Summary:
- The study included 98 patients with coronary disease and 31 controls, all undergoing coronary angiography.
- Electrocardiographic analysis revealed LBBB in a subset of patients, with specific conduction disruptions like LBBB+LAH found in 17.34% of ill examinees.
- Coronary artery stenosis averaged 77.5% in patients with CAD. Among those with LBBB, one-artery disease was most common, frequently involving the LAD, while LPH was not observed in the CAD group.
Impact:
- Findings highlight the challenges LBBB poses for diagnosing CAD and suggest specific electrocardiographic patterns may correlate with coronary artery disease extent.
- This research aids in refining diagnostic strategies for CAD in patients presenting with LBBB.
- Understanding these associations can improve patient risk stratification and guide clinical decision-making in cardiology.
Abstract:
In the LBBB (the block of the left branch) control group there were 2 examinees Hi (6.45%). LAH and LHP were not found. The block of the left branch often creates problems in electrocardiographic diagnosis of coronary disease. It can be registered as complete LBBB, anterior-left hemiblock (LAH) and posterior-left hemiblock (LPH). The combinations are possible with the block of the right branch (RBBB) and A-V blocks. The most frequent cause is coronary disease, and next is sclerodegenerative changes in heart intrinsic-conduction system. Our study involves 98 of examinees with coronary disease, and 78 of that number are males and 24 are females, all average-aged 60.83+/-12.6. Control group (examinees who do not suffer from coronary disease) is made of 31 subjects, and 24 of that number are males, and 7 are females, all average-aged 57.16+/-10.4. Those diagnosed with coronary disease, as the examinees from control group, had the indications for the coronagraphy. The coronagraphy was performed and electrocardiographic findings were analyzed. The average degree of coronary arteries stenosis of the ill examinees was 77.5+/-14.9%, and in the examined group 23.5+/-12.5%. Of the examinees with the block of the left branch, 4 Hi examinees had one-artery illness (4.08%), 3 Hi had two-artery illness (3.06%) and 1 Hi had three-artery illness (1.02%). In one-artery coronary disease LAD stenosis was most frequent. Disruptions in conduction LBBB+LAH was found in 17.34% ill examinees, and 8.16% of those from LBBB and 9.8% from LHH. Of examinees with LAH, one-vessel coronary disease was found in 5.1% and two-vessel coronary disease in 4.08%. The most frequent was LAD stenosis, rarely combined with CX stenosis, and in one case LAD combined with RCA stenosis. In group with coronary disease LPH was not found.
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