Key result
In primary care patients with left bundle branch block, the combination of a prolonged QRS duration (≥150 ms) and a heart rate ≥70 bpm increased the risk of developing heart failure by over threefold (HR 3.17).
Why the study?
Left bundle branch block is associated with an increased risk of heart failure, but the impact of common ECG parameters on this association remained to be assessed.
Does prolonged QRS duration and higher heart rate increase the risk of heart failure in primary care patients with left bundle branch block?
Cohort (n=2,471)
Does prolonged QRS duration and higher heart rate increase the risk of heart failure in primary care patients with left bundle branch block?
Hazard Ratio: 3.17 (95% CI 2.41–4.18)
p-value: p=<0.001
In patients with LBBB, the combination of QRS ≥150 ms and heart rate ≥70 bpm identifies a high-risk subgroup for developing heart failure, suggesting a need for closer monitoring or early referral.
Aim Left bundle branch block (LBBB) is associated with an increased risk of heart failure (HF). We assessed the impact of common ECG parameters on this association using large-scale data. Methods and results Using ECGs recorded in a large primary care population from 2001 to 2011, we identified HF-naive patients with a first-time LBBB ECG. We obtained information on sex, age, emigration, medication, diseases and death from Danish registries. We investigated the association between the PR interval, QRS duration, and heart rate and the risk of HF over a 2-year follow-up period using Cox regression analysis. Of 2471 included patients with LBBB, 464 (18.8%) developed HF during follow-up. A significant interaction was found between QRS duration and heart rate (p<0.01), and the analyses were stratified on these parameters. Using a QRS duration <150 ms and a heart rate <70 beats per minute (bpm) as the reference, all groups were statistically significantly associated with the development of HF. Patients with a QRS duration ≥150 ms and heart rate ≥70 bpm had the highest risk of developing HF (HR 3.17 (95% CI 2.41 to 4.18, p < 0.001). There was no association between the PR interval and HF after adjustment. Conclusion Prolonged QRS duration and higher heart rate were associated with increased risk of HF among primary care patients with LBBB, while no association was observed with PR interval. Patients with LBBB with both a prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) have the highest risk of developing HF.
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Søndergaard et al. (2021) conducted a cohort in Left bundle branch block (LBBB) without prior heart failure (n=2,471). Prolonged QRS duration (≥150 ms) and higher heart rate (≥70 bpm) vs. QRS duration <150 ms and heart rate <70 bpm was evaluated on Development of heart failure (HR 3.17, 95% CI 2.41-4.18, p=<0.001). In primary care patients with left bundle branch block, the combination of a prolonged QRS duration (≥150 ms) and a heart rate ≥70 bpm increased the risk of developing heart failure by over threefold (HR 3.17).
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