Prognosis of incidental left bundle branch block
Abbasin Zegard1, Osita Okafor1, Joseph de Bono2
1Department of Cardiology, Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham B15 2TH, UK.
Summary
Cardiovascular magnetic resonance (CMR) risk-stratifies patients with incidental left bundle branch block (iLBBB). Abnormal CMR findings indicate poor outcomes, while normal findings suggest comparable survival to controls.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Incidental left bundle branch block (iLBBB) frequently leads to cardiology referrals, often with prognostic uncertainty.
- Current risk stratification methods for iLBBB lack definitive prognostic value.
Purpose of the Study:
- To assess the utility of cardiovascular magnetic resonance (CMR) in risk stratification for patients with iLBBB.
- To determine if CMR can differentiate prognosis in patients with iLBBB.
Main Methods:
- A cohort of 193 patients with iLBBB underwent CMR.
- Patients were categorized into abnormal (iLBBBCMR+) or normal (iLBBBCMR-) CMR phenotypes.
- Clinical events were tracked over a median of 3.75 years, with outcomes compared to a control group (n=107).
Main Results:
- 56.9% of iLBBB patients had an abnormal CMR phenotype (iLBBBCMR+).
- iLBBBCMR+ patients exhibited significantly higher total mortality and major adverse cardiac events (MACEs) compared to controls.
- iLBBBCMR- patients had similar total mortality to controls but increased MACEs.
- Myocardial fibrosis and left ventricular ejection fraction (LVEF) ≤50% were independent predictors of mortality in iLBBB patients, with a combined additive effect.
Conclusions:
- Patients with iLBBB and abnormal CMR findings (iLBBBCMR+) face poor outcomes.
- Patients with iLBBB and normal CMR findings (iLBBBCMR-) have survival comparable to controls, though MACE risk is elevated.
- CMR is crucial for risk-stratifying iLBBB patients, identifying those at higher risk who may benefit from further intervention.
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