Prognostic Significance of Left Axis Deviation in Acute Heart Failure Patients with Left Bundle branch block: an Analysis from the Korean Acute Heart Failure (KorAHF) Registry

Ki Hong Choi, Seongwook Han, Ga Yeon Lee, Jin Oh Choi, Eun Seok Jeon, Hae Young Lee, Sang Eun Lee, Jae Joong Kim, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Myeong Chan Cho, Hyun Young Park, Byung Hee Oh, Ki Hong Choi, Seongwook Han, Ga Yeon Lee, Jin Oh Choi, Eun Seok Jeon, Hae Young Lee, Sang Eun Lee, Jae Joong Kim, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Myeong Chan Cho, Hyun Young Park, Byung Hee Oh

Abstract

Background and objectives: The prognostic impact of left axis deviation (LAD) on clinical outcomes in acute heart failure syndrome (AHFS) with left bundle branch block (LBBB) is unknown. The aim of this study was to determine the prognostic significance of axis deviation in acute heart failure patients with LBBB.

Methods: Between March 2011 and February 2014, 292 consecutive AHFS patients with LBBB were recruited from 10 tertiary university hospitals. They were divided into groups with no LAD (n=189) or with LAD (n=103) groups according to QRS axis <-30 degree. The primary outcome was all-cause mortality.

Results: The median follow-up duration was 24 months. On multivariate analysis, the rate of all-cause death did not significantly differ between the normal axis and LAD groups (39.7% vs. 46.6%, adjusted hazard ratio, 1.01; 95% confidence interval, 0.66, 1.53; p=0.97). However, on the multiple linear regression analysis to evaluate the predictors of the left ventricular ejection fraction (LVEF), presence of LAD significantly predicted a worse LVEF (adjusted beta, -3.25; 95% confidence interval, -5.82, -0.67; p=0.01). Right ventricle (RV) dilatation was defined as at least 2 of 3 electrocardiographic criteria (late R in lead aVR, low voltages in limb leads, and R/S ratio <1 in lead V₅) and was more frequent in the LAD group than in the normal axis group (p<0.001).

Conclusions: Among the AHFS with LBBB patients, LAD did not predict mortality, but it could be used as a significant predictor of worse LVEF and RV dilatation (Trial registry at KorAHF registry, ClinicalTrial.gov, NCT01389843).

Keywords: Bundle-branch block; Electrocardiography; Heart failure.

Conflict of interest statement

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors have no financial conflicts of interest.

Copyright © 2018. The Korean Society of Cardiology.

Figures

Figure 1. Study flow.
Figure 1. Study flow.
AHFS = acute heart failure syndrome; ECG = electrocardiogram; IVCD = intra-ventricular conduction delay; KorAHF = Korean Acute Heart Failure; LAD = left axis deviation; LBBB = left bundle branch block; RBBB = right bundle branch block.
Figure 2. Kaplan-Meier curves of AHFS patients…
Figure 2. Kaplan-Meier curves of AHFS patients with LBBB according to the presence of LAD. Kaplan-Meier curve of all-cause death for AHFS patients with LBBB in the no LAD group (blue line) versus the LAD group (red line).
AHFS = acute heart failure syndrome; LAD = left axis deviation; LBBB = left bundle branch block.
Figure 3. LOESS curves of the echocardiographic…
Figure 3. LOESS curves of the echocardiographic parameters according to the QRS axis. LOESS curves of the LVEF (A), E/A ratio (B), E/e′ (C), DT (D), LA size (E), and RVSP (F) according to the QRS axis.
DT = deceleration time; LA = left atrium; LOESS = locally weighted scatterplot smoothing; LVEF = left ventricular ejection fraction; RVSP = right ventricular systolic pressure.
Figure 4. Kaplan-Meier curve of all-cause death…
Figure 4. Kaplan-Meier curve of all-cause death in AHFS patients with LBBB according to RV dilatation criteria. Kaplan-Meier curve of all-cause death in AHFS patients with LBBB in the no RV dilatation group (blue line) versus RV dilatation group (red line).
AHFS = acute heart failure syndrome; LBBB = left bundle branch block; RV = right ventricle.

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Source: PubMed

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