Key result
New-onset LBBB linked to ~60% greater risk of major clinical events in LV systolic dysfunction.
Why the study?
It remains unclear whether elevated ventricular wall pressure and left ventricular enlargement in patients with left ventricular systolic dysfunction lead to left bundle branch block.
Does new-onset LBBB predict adverse clinical outcomes in hospitalized patients with left ventricular systolic dysfunction?
Cohort (n=801)
No
Does new-onset LBBB predict adverse clinical outcomes in hospitalized patients with left ventricular systolic dysfunction?
Hazard Ratio: 1.603 (95% CI 1.207–2.129)
p-value: p=0.001
In patients with left ventricular systolic dysfunction, new-onset LBBB is independently associated with a poor prognosis and increased risk of adverse cardiovascular events.
New-onset LBBB may signal higher risk in LVSD; leaves open whether preventing it improves outcomes.
It remains unclear whether elevated ventricular wall pressure and left ventricular enlargement in patients with left ventricular systolic dysfunction (LVSD) can lead to left bundle branch block (LBBB). In this study, 801 consecutive hospitalized patients with a left ventricular ejection fraction of < 50% were enrolled. The primary outcome was the occurrence of new-onset LBBB or heart failure-related hospitalization, all-cause mortality, ventricular tachycardia, or implantation of an implantable cardioverter-defibrillator (ICD) /cardiac resynchronization therapy (CRT). During a median follow-up of 56 months, 70 cases of new-onset LBBB were observed, with a cumulative incidence rate of 10.1%. Multivariate Cox regression analysis demonstrated that paroxysmal atrial fibrillation (PAF) (hazard ratio [HR] 2.907, 95% confidence interval [CI] 1.552-5.444, P = 0.001), coronary artery disease (CAD) (HR 6.680, 95% CI 3.451-12.930, P < 0.001), dilated cardiomyopathy (DCM) (HR 6.394, 95% CI 3.501-11.675, P < 0.001), QRS duration (HR 1.018, 95% CI 1.010-1.027, P < 0.001), left ventricular end-diastolic dimension (LVEDD) (HR 1.032, 95% CI 1.006-1.059, P = 0.016), and β-blockers (HR 0.327, 95% CI 0.199-0.536, P < 0.001) were independent predictors of new-onset LBBB. A Kaplan-Meier survival curve analysis demonstrated that patients with new-onset LBBB had a higher incidence of composite endpoint events (P < 0.001), heart failure-related hospitalization (P < 0.001), and ventricular tachycardia or implantation of an ICD or CRT (P < 0.001) than patients without new-onset LBBB. Moreover, new-onset LBBB (HR 1.603, 95% CI 1.207-2.129, P = 0.001) was an independent predictor of composite endpoint events.DCM, LVEDD, CAD, PAF, and QRS duration were independent predictive factors for the subsequent development of LBBB in patients with LVSD. New-onset LBBB was independently associated with a poor prognosis.
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Li et al. (2024) conducted a cohort in Left ventricular systolic dysfunction (n=801). New-onset LBBB vs. No new-onset LBBB was evaluated on Composite of heart failure-related hospitalization, all-cause mortality, ventricular tachycardia, or ICD/CRT implantation (HR 1.603, 95% CI 1.207-2.129, p=0.001). New-onset LBBB was an independent predictor of composite clinical endpoint events (HR 1.603) in patients with left ventricular systolic dysfunction.
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