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Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2007 May; Vol. 9 (5), pp. 510-7. Date of Electronic Publication: 2007 Feb 20. - Publication Year :
- 2007
-
Abstract
- Background: Bundle branch block (BBB) is a powerful independent predictor of cardiovascular mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). The prognostic implications in HF with preserved systolic function (HF-PSF) are less well understood.<br />Methods: The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomised 7599 patients with symptomatic HF to receive candesartan or placebo. The primary outcome comprised cardiovascular death or HF hospitalisation. The relative risk conveyed by BBB relative to a normal electrocardiogram was examined.<br />Results: The prevalence of BBB was significantly lower in patients with preserved compared with reduced systolic function (CHARM-Preserved 14.4%, Alternative 29.6%, Added 30.5%), p<0.0001. Overall, the adjusted hazard ratio for the primary outcome was 1.48 (95% confidence interval 1.22-1.78), p<0.0001, reflecting increased risk in patients with reduced LVEF (1.72 [1.28-2.31], p=0.0003). The apparently more modest risk among patients with HF-PSF was significant in unadjusted (1.80 [1.37-2.37], p<0.0001) but not adjusted analysis (1.16 [0.88-1.54], p=0.2897). However, no formal statistical difference was observed between the two cohorts, and interpretation is limited by the unknown prevalence of left and right BBB morphologies in each. Comparing BBB presence with absence yielded qualitatively similar results.<br />Conclusion: The simple clinical finding of BBB is a powerful independent predictor of worse clinical outcomes in patients with HF and reduced LVEF. It is less frequent, with a more modest predictive effect, in patients with preserved systolic function.
- Subjects :
- Aged
Biphenyl Compounds
Bundle-Branch Block etiology
Bundle-Branch Block physiopathology
Bundle-Branch Block prevention & control
Double-Blind Method
Electrocardiography
Female
Follow-Up Studies
Heart Failure complications
Heart Failure physiopathology
Humans
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Prevalence
Prognosis
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk Factors
Stroke Volume
Survival Analysis
Treatment Outcome
Ventricular Dysfunction, Left drug therapy
Ventricular Dysfunction, Left epidemiology
Angiotensin II Type 1 Receptor Blockers therapeutic use
Benzimidazoles therapeutic use
Bundle-Branch Block epidemiology
Heart Failure drug therapy
Heart Failure epidemiology
Tetrazoles therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1388-9842
- Volume :
- 9
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 17317308
- Full Text :
- https://doi.org/10.1016/j.ejheart.2006.11.006