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Updated: May 28, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Prognostic value of exercise stress echocardiography in patients with left bundle branch block
Francis de Lima Vasconcelos1, Bruno Fernandes de Oliveira Santos, Nathalie de Oliveira Santana
1Departamento de Medicina, Universidade Federal de Sergipe, São Cristovão, SE, Brazil.
Insights
Exercise stress echocardiography (ESE) can predict cardiac events in patients with complete left bundle branch block (LBBB). A positive ESE indicates a higher risk of adverse cardiac outcomes in this population.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Prognostics
Background:
- Limited research exists on the prognostic implications of exercise stress echocardiography (ESE) for individuals with complete left bundle branch block (LBBB).
- Complete LBBB can complicate the interpretation of traditional stress tests, necessitating further investigation into alternative prognostic markers.
Purpose of the Study:
- To evaluate the predictive capability of ESE in determining cardiac events among patients diagnosed with LBBB.
- To establish ESE as a potential tool for risk stratification in this specific patient group.
Main Methods:
- A retrospective cohort study included 135 patients with LBBB who underwent ESE using the Bruce protocol.
- Outcomes analyzed included all-cause mortality and major cardiac events such as acute myocardial infarction (AMI), percutaneous angioplasty (PA), and coronary artery bypass grafting (CABG).
- Cox regression analysis was employed to assess the prognostic value of ESE findings.
Main Results:
- A positive ESE result was identified in 31% of the patients.
- Over a mean follow-up of 45.8 months, the rate of cardiac events within five years was significantly higher in the positive ESE group (15.1%) compared to the negative ESE group (1.6%) (p = 0.009).
- While all-cause mortality showed a trend, it did not reach statistical significance between the groups.
Conclusions:
- Exercise stress echocardiography demonstrates significant prognostic value for predicting cardiac events in patients with complete left bundle branch block.
- ESE can aid clinicians in identifying high-risk LBBB patients who may benefit from closer monitoring or intervention.
Background:
The literature lacks studies about the prognostic value of exercise stress echocardiography (ESE) in patients with complete left bundle branch block (LBBB) of the bundle of His.
Objective:
To assess the prognostic value of ESE in patients with LBBB.
Methods:
This is a retrospective cohort that evaluated 135 patients with LBBB, from January 2001 to October 2009, of which 37.8% were men, mean age 63.6 ± 11.5 years submitted to ESE according to Bruce protocol on a treadmill. Cox regression was used, considering these outcomes: death from all causes and from cardiac events, defined as acute myocardial infarction (AMI), percutaneous angioplasty (PA), coronary artery bypass grafting (CABG) and death from cardiac causes.
Results:
Positive ESE was observed in 42 patients (31%). The mean follow-up was 45.8 ± 4.7 months. During this period, there were 9 deaths from all causes and 9 cardiac events (3 deaths from cardiac causes, 3 myocardial infarctions, 2 PA and one CABG). The mortality rate from all causes during five years was 16.1% in the group with positive ESE and 2.5% in the group with negative test (p = 0.171), whereas the rate of cardiac events in the same period was 15.1% for the positive ESE and 1.6% in the group with negative test (p = 0.009).
Conclusion:
ESE showed to be a predictor of cardiac events in patients with LBBB.
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