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Int J Angiol
DOI: 10.1055/a-2516-2082
Original Article

Association of Left and Right Branch Blocks with Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction

Sukhila Reddy
1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
,
Lakshmi Kattamuri 
1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
,
Alok Dwivedi
2   Division of Biostatistics and Epidemiology, Department of Molecular and Translational Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
,
Debabrata Mukherjee 
1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
,
Abhizith Deoker 
1   Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
› Author Affiliations Funding This study was funded by the 2023 Internal Medicine SEED Grant by Texas Tech University, El Paso.
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Abstract

The associations of left bundle branch block (LBBB) and right bundle branch block (RBBB) with cardiovascular (CV) outcomes compared with normal QRS in heart failure patients with preserved ejection fraction (HFpEF) are unclear. We sought to determine CV morbidity, mortality, and total costs associated with LBBB and RBBB in acute HFpEF compared with those without BBB. A cross-sectional study using the 2019 NIS database analyzed adult HFpEF hospitalizations for acute heart failure, categorizing patients by LBBB, RBBB, or normal QRS. Clinical outcomes included atrial fibrillation (AF), ventricular fibrillation (VF), complete heart block (CHB), sick sinus syndrome (SSS), cardiac arrest (CA), hospitalization costs, and in-hospital mortality. Associations between BBB types and outcomes were assessed using logistic and relative risk (RR) models with propensity score weighting, validated by sensitivity analyses. A total of 334,511 hospitalizations with HFpEF including LBBB (6,818, 2%) and RBBB (7,948, 2.4%) were analyzed. Compared with normal QRS duration, LBBB was associated with VF (odds ratio [OR] = 2.47, p < 0.001), SSS (OR = 1.72, p < 0.001), CHB (OR = 2.77, p < 0.001) and greater hospitalization costs (RR = 1.15, p < 0.001) after adjusting for covariates in PS analysis. Similarly, RBBB was associated with AF (OR = 1.30, p < 0.001), VF (OR = 1.59, p = 0.033), SSS (OR = 1.72, p < 0.001), CHB (OR = 2.81, p < 0.001), CA (OR = 1.19, p < 0.001), and higher hospitalization costs (RR = 1.08, p < 0.001). These associations remained unchanged in multiple validation analyses even after additionally adjusting for obesity, hypertension, and diabetes. The length of stay was shorter in HFpEF with RBBB and LBBB subgroups compared with normal QRS. In hospitalizations of acute decompensated HFpEF, BBB was associated with an increased risk of CV outcomes and hospitalization costs.

Keywords

heart failure with preserved ejection fraction - left bundle branch block - right bundle branch block - atrial fibrillation - ventricular arrhythmias - cardiovascular disease outcomes

Authors' Contributions

S.R. and L.K. wrote the manuscript and conducted the literature review. S.R., D.M., and A.D. conceived the idea. A.D. performed statistical analysis, assisted in manuscript development, critically reviewed, and approved the article, and is the article's guarantor. All authors reviewed and approved of the whole manuscript.


Supplementary Material



Publication History

Article published online:
31 January 2025

© 2025. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Eriksson P, Hansson PO, Eriksson H, Dellborg M. Bundle-branch block in a general male population: the study of men born 1913. Circulation 1998; 98 (22) 2494-2500
    CrossrefPubMedSearch in Google Scholar
  • 2 Eriksson P, Wilhelmsen L, Rosengren A. Bundle-branch block in middle-aged men: risk of complications and death over 28 years. The primary prevention study in Göteborg, Sweden. Eur Heart J 2005; 26 (21) 2300-2306
    CrossrefPubMedSearch in Google Scholar
  • 3 Messer AL, Johnson RP, Shreenivas, White PD. Prognosis in bundle branch block. II. A comparison of right and left bundle branch block with a note on the relative incidence of each. Am Heart J 1951; 41 (02) 239-245
    PubMedSearch in Google Scholar
  • 4 Schneider JF, Thomas Jr HE, Kreger BE, McNamara PM, Kannel WB. Newly acquired left bundle-branch block: the Framingham study. Ann Intern Med 1979; 90 (03) 303-310
    CrossrefPubMedSearch in Google Scholar
  • 5 Francia P, Balla C, Paneni F, Volpe M. Left bundle-branch block–pathophysiology, prognosis, and clinical management. Clin Cardiol 2007; 30 (03) 110-115
    CrossrefPubMedSearch in Google Scholar
  • 6 Auricchio A, Fantoni C, Regoli F. et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation 2004; 109 (09) 1133-1139
    CrossrefPubMedSearch in Google Scholar
  • 7 Das MK, Cheriparambil K, Bedi A. et al. Prolonged QRS duration (QRS >/=170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?. Am Heart J 2001; 142 (05) 756-759
    CrossrefPubMedSearch in Google Scholar
  • 8 Tang AS, Wells GA, Talajic M. et al. Resynchronization-Defibrillation for Ambulatory Heart Failure Trial Investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010; 363 (25) 2385-2395
    CrossrefPubMedSearch in Google Scholar
  • 9 Heidenreich PA, Bozkurt B, Aguilar D. et al. ACC/AHA Joint Committee Members. AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 2022; 145 (18) e895-e1032
    CrossrefPubMedSearch in Google Scholar
  • 10 Dahal R, Nickel N, Mukherjee D, Alkhateeb H. Current updates in the pharmacotherapy of heart failure with a preserved ejection fraction. Cardiovasc Hematol Disord Drug Targets 2022; 22 (02) 87-95
    CrossrefPubMedSearch in Google Scholar
  • 11 Mares A, Rodriguez T, Deoker A, Lehker A, Mukherjee D. Effect of mineralocorticoid receptor antagonists in heart failure with preserved ejection fraction and with reduced ejection fraction: a narrative review. Curr Vasc Pharmacol 2022; 20 (01) 46-51
    CrossrefPubMedSearch in Google Scholar
  • 12 Adabag S, Rector TS, Anand IS. et al. A prediction model for sudden cardiac death in patients with heart failure and preserved ejection fraction. Eur J Heart Fail 2014; 16 (11) 1175-1182
    CrossrefPubMedSearch in Google Scholar
  • 13 Danciu SC, Gonzalez J, Gandhi N, Sadhu S, Herrera CJ, Kehoe R. Comparison of six-month outcomes and hospitalization rates in heart failure patients with and without preserved left ventricular ejection fraction and with and without intraventricular conduction defect. Am J Cardiol 2006; 97 (02) 256-259
    CrossrefPubMedSearch in Google Scholar
  • 14 Dwivedi AK, Vishwakarma D, Dubey P, Reddy S. Association of polycystic ovary syndrome with cardiovascular disease among female hospitalizations in the United States. Eur J Endocrinol 2023; 188 (06) 555-563
    CrossrefPubMedSearch in Google Scholar
  • 15 Dwivedi AK, Shukla R. Evidence-based statistical analysis and methods in biomedical research (SAMBR) checklists according to design features. Cancer Rep (Hoboken) 2020; 3 (04) e1211
    CrossrefPubMedSearch in Google Scholar
  • 16 Xiao HB, Roy C, Fujimoto S, Gibson DG. Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy. Int J Cardiol 1996; 53 (02) 163-170
    CrossrefPubMedSearch in Google Scholar
  • 17 Kashani A, Barold SS. Significance of QRS complex duration in patients with heart failure. J Am Coll Cardiol 2005; 46 (12) 2183-2192
    CrossrefPubMedSearch in Google Scholar
  • 18 Moss AJ, Hall WJ, Cannom DS. et al. MADIT-CRT Trial Investigators. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361 (14) 1329-1338
    CrossrefPubMedSearch in Google Scholar
  • 19 Bristow MR, Saxon LA, Boehmer J. et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350 (21) 2140-2150
    CrossrefPubMedSearch in Google Scholar
  • 20 Sze E, Samad Z, Dunning A. et al. Impaired recovery of left ventricular function in patients with cardiomyopathy and left bundle branch block. J Am Coll Cardiol 2018; 71 (03) 306-317
    CrossrefPubMedSearch in Google Scholar
  • 21 Santos AB, Kraigher-Krainer E, Bello N. et al. Left ventricular dyssynchrony in patients with heart failure and preserved ejection fraction. Eur Heart J 2014; 35 (01) 42-47
    CrossrefPubMedSearch in Google Scholar
  • 22 Chung ES, Katra RP, Ghio S. et al. Cardiac resynchronization therapy may benefit patients with left ventricular ejection fraction >35%: a PROSPECT trial substudy. Eur J Heart Fail 2010; 12 (06) 581-587
    CrossrefPubMedSearch in Google Scholar
  • 23 Lund LH, Jurga J, Edner M. et al. Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J 2013; 34 (07) 529-539
    CrossrefPubMedSearch in Google Scholar
  • 24 Donal E, Lund LH, Oger E. et al. KaRen Investigators. Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study. Arch Cardiovasc Dis 2014; 107 (02) 112-121
    CrossrefPubMedSearch in Google Scholar
  • 25 Joseph J, Claggett BC, Anand IS. et al. QRS duration is a predictor of adverse outcomes in heart failure with preserved ejection fraction. JACC Heart Fail 2016; 4 (06) 477-486
    CrossrefPubMedSearch in Google Scholar
  • 26 Penicka M, Kocka V, Herman D, Trakalova H, Herold M. Cardiac resynchronization therapy for the causal treatment of heart failure with preserved ejection fraction: insight from a pressure-volume loop analysis. Eur J Heart Fail 2010; 12 (06) 634-636
    CrossrefPubMedSearch in Google Scholar
  • 27 Mathew D, Agarwal S, Sherif A. Impact of left bundle branch block on heart failure with preserved ejection fraction. Pacing Clin Electrophysiol 2023; 46 (05) 422-424
    CrossrefPubMedSearch in Google Scholar
  • 28 Sipahi I, Chou JC, Hyden M, Rowland DY, Simon DI, Fang JC. Effect of QRS morphology on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Am Heart J 2012; 163 (02) 260-7.e3
    CrossrefPubMedSearch in Google Scholar
  • 29 Cunnington C, Kwok CS, Satchithananda DK. et al. Cardiac resynchronisation therapy is not associated with a reduction in mortality or heart failure hospitalisation in patients with non-left bundle branch block QRS morphology: meta-analysis of randomised controlled trials. Heart 2015; 101 (18) 1456-1462
    CrossrefPubMedSearch in Google Scholar
  • 30 Friedman DJ, Al-Khatib SM, Dalgaard F. et al. Cardiac resynchronization therapy improves outcomes in patients with intraventricular conduction delay but not right bundle branch block: a patient-level meta-analysis of randomized controlled trials. Circulation 2023; 147 (10) 812-823
    CrossrefPubMedSearch in Google Scholar