Association of left bundle branch block with obstructive coronary artery disease on coronary CT angiography: a case–control study

AIMS: Left bundle branch block (LBBB) is considered an unfavourable prognostic marker in patients with underlying heart disease. Testing for coronary artery disease (CAD) is often prompted by incidental LBBB finding, but published studies disagree about a significant association between LBBB and CAD. We therefore assessed the association of LBBB with previously unknown CAD in patients undergoing coronary computed tomography angiography (CCTA). METHODS AND RESULTS: We enrolled 818 patients (mean age 57.2 ± 11.1 years, 106 patients with presumably new LBBB and 712 controls) without known CAD who underwent 64-slice CCTA. Image quality was assessed for each coronary segment. Comparison of obstructive CAD prevalence (defined as ≥50% stenosis) was performed using triple case-matching for pre-test probability (based on age, gender, and symptom typicality) in 101 LBBB patients and 303 matched controls with diagnostic quality in all segments. We found no difference in obstructive CAD prevalence between LBBB patients and matched controls (15 vs. 16%, P = 0.88). Similarly, there were no significant differences in cardiovascular risk factors (CVRF), stenosis severity, CAD extent, non-obstructive CAD, and vessel-based analysis between patient groups. Image quality was very high in LBBB patients and comparable to controls. On multivariate analysis, age, gender, typical angina, and CVRF, but not LBBB (P = 0.94), emerged as significant and independent predictors of obstructive CAD. CONCLUSION: CAD prevalence is similar in LBBB patients at low-to-moderate pre-test probability compared with controls with similar CVRF matched for age, gender, and symptom typicality. CCTA is a useful imaging modality in LBBB patients, providing comparable image quality to non-LBBB controls.