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Major Left Bundle Branch Block and Coronary Heart Disease-Are There Any Differences between the Sexes?
Diana Gurzău1, Alexandra Dădârlat-Pop1, Bogdan Caloian1
1"Iuliu Hațieganu", University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Insights
Left bundle branch block (LBBB) in women with ischemic heart disease often presents with normal coronary arteries and microvascular dysfunction, unlike men. LBBB may indicate microvascular angina, particularly in women.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Science
Background:
- Left bundle branch block (LBBB) is a significant cardiac finding requiring investigation for underlying causes like ischemic heart disease.
- LBBB is noted to be more prevalent with normal coronary arteries in women.
- Understanding sex-specific differences in LBBB associated with ischemic heart disease is crucial.
Purpose of the Study:
- To investigate and compare the characteristics of LBBB in women versus men with ischemic heart disease.
- To identify potential sex-based disparities in risk factors, electrocardiographic, echocardiographic, and angiographic findings.
Main Methods:
- A study cohort of seventy patients diagnosed with LBBB and ischemic heart disease was analyzed.
- Data collected included patient demographics, risk factors, electrocardiographic parameters (QRS duration), echocardiographic measurements (left ventricular diameter, ejection fraction), and coronary angiography results.
- Statistical analyses were performed to compare differences between men and women.
Main Results:
- No significant differences in risk factor profiles were observed between sexes, except for smoking and uric acid levels.
- Men exhibited longer QRS duration (ventricular depolarization) and larger left ventricular diameters compared to women.
- A significant inverse association was found between LBBB duration and left ventricular ejection fraction, especially pronounced in women. Angiography revealed normal epicardial arteries in 80% of women versus 65.7% of men, with all these patients showing microvascular dysfunction.
Conclusions:
- Sex-based differences in LBBB associated with ischemic heart disease are more apparent in electrocardiographic, echocardiographic, and angiographic findings than in traditional risk factors.
- LBBB in women with ischemic heart disease is strongly linked to microvascular dysfunction and may serve as a marker for microvascular angina and systolic dysfunction.
Abstract:
Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = -0.52, p = 0.0012 vs. R = -0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.
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