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Published in: BMC Cardiovascular Disorders 1/2016

Open Access 01-12-2016 | Research article

Effects of ventricular conduction block patterns on mortality in hospitalized patients with dilated cardiomyopathy: a single-center cohort study

Authors: Xiaoping Li, Rong Luo, Wei Fang, Xiaolei Xu, Guodong Niu, Yixian Xu, Michael Fu, Wei Hua, Xiushan Wu

Published in: BMC Cardiovascular Disorders | Issue 1/2016

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Abstract

Background

Ventricular conduction blocks (VCBs) are associated with poor outcomes in patients with known cardiac diseases. However, the prognostic implications of VCB patterns in dilated cardiomyopathy (DCM) patients need to be evaluated. The purpose of this study was to determine all-cause mortality in patients with DCM and VCB.

Methods

This cohort study included 1119 DCM patients with a median follow-up of 34.3 (19.5–60.8) months, patients were then divided into left bundle branch block (LBBB), right bundle branch block (RBBB), intraventricular conduction delays (IVCD) and narrow QRS groups. The all-cause mortality was assessed using Kaplan-Meier survival curves and Cox regression.

Results

Of those 1119 patients, the all-cause mortality rates were highest in patients with IVCD (47.8, n = 32), intermediate in those with RBBB (32.9, n = 27) and LBBB (27.1 %, n = 60), and lowest in those with narrow QRS (19.9 %, n = 149). The all-cause mortality risk was significantly different between the VCB and narrow QRS group (log-rank χ2 = 51.564, P < 0.001). The presence of RBBB, IVCD, PASP ≥ 40 mmHg, left atrium diameter and NYHA functional class were independent predictors of all-cause mortality in DCM patients.

Conclusions

Our findings indicate that RBBB and IVCD at admission,but not LBBB, were independent predictors of all-cause mortality in patients with DCM.
Literature
1.
go back to reference Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defi brillation in Chronic Heart Failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail. 2000;6:276–85.CrossRefPubMed Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defi brillation in Chronic Heart Failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail. 2000;6:276–85.CrossRefPubMed
2.
go back to reference Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567–73.CrossRefPubMed Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567–73.CrossRefPubMed
3.
go back to reference Shamim W, Francis DP, Yousufuddin M, Varney S, Pieopli MF, Anker SD, et al. Intraventricular conduction delay: a prognostic marker in chronic heart failure. Int J Cardiol. 1999;70:171–8.CrossRefPubMed Shamim W, Francis DP, Yousufuddin M, Varney S, Pieopli MF, Anker SD, et al. Intraventricular conduction delay: a prognostic marker in chronic heart failure. Int J Cardiol. 1999;70:171–8.CrossRefPubMed
4.
go back to reference McCullough PA, Hassan SA, Pallekonda V, Sandberg KR, Nori DB, Soman SS, et al. Bundle branch block patterns, age, renal dysfunction, and heart failure mortality. Int J Cardiol. 2005;102:303–8.CrossRefPubMed McCullough PA, Hassan SA, Pallekonda V, Sandberg KR, Nori DB, Soman SS, et al. Bundle branch block patterns, age, renal dysfunction, and heart failure mortality. Int J Cardiol. 2005;102:303–8.CrossRefPubMed
5.
go back to reference Baldasseroni S, Gentile A, Gorini M, Marchionni N, Marini M, Masotti G, et al. Intraventricular conduction defects in patients with congestive heart failure: left but not right bundle branch block is an independent predictor of prognosis. A report from the Italian Network on Congestive Heart Failure (IN-CHF database). Ital Heart J. 2003;4:607–13.CrossRefPubMed Baldasseroni S, Gentile A, Gorini M, Marchionni N, Marini M, Masotti G, et al. Intraventricular conduction defects in patients with congestive heart failure: left but not right bundle branch block is an independent predictor of prognosis. A report from the Italian Network on Congestive Heart Failure (IN-CHF database). Ital Heart J. 2003;4:607–13.CrossRefPubMed
6.
go back to reference Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002;143:398–405.CrossRefPubMed Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, et al. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002;143:398–405.CrossRefPubMed
7.
go back to reference Mueller C, Laule-Kilian K, Klima T, Breidthardt T, Hochholzer W, Perruchoud AP, et al. Right bundle branch block and long-term mortality in patients with acute congestive heart failure. J Intern Med. 2006;260:421–8.CrossRefPubMed Mueller C, Laule-Kilian K, Klima T, Breidthardt T, Hochholzer W, Perruchoud AP, et al. Right bundle branch block and long-term mortality in patients with acute congestive heart failure. J Intern Med. 2006;260:421–8.CrossRefPubMed
8.
go back to reference Zimetbaum PJ, Buxton AE, Batsford W, Fisher JD, Hafley GE, Lee KL, et al. Electrocardiographic predictors of arrhythmic death and total mortality in the multicenter unsustained tachycardia trial. Circulation. 2004;110:766–9.CrossRefPubMed Zimetbaum PJ, Buxton AE, Batsford W, Fisher JD, Hafley GE, Lee KL, et al. Electrocardiographic predictors of arrhythmic death and total mortality in the multicenter unsustained tachycardia trial. Circulation. 2004;110:766–9.CrossRefPubMed
9.
go back to reference Barsheshet A, Leor J, Goldbourt U, Garty M, Schwartz R, Behar S, et al. Effect of bundle branch block patterns on mortality in hospitalized patients with heart failure. Am J Cardiol. 2008;101:1303–8.CrossRefPubMed Barsheshet A, Leor J, Goldbourt U, Garty M, Schwartz R, Behar S, et al. Effect of bundle branch block patterns on mortality in hospitalized patients with heart failure. Am J Cardiol. 2008;101:1303–8.CrossRefPubMed
10.
go back to reference Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish-Farkash A, et al. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol. 2011;107:540–4.CrossRefPubMed Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish-Farkash A, et al. Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol. 2011;107:540–4.CrossRefPubMed
11.
go back to reference Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16.
13.
go back to reference Mohan SB, Parker M, Wehbi M, Douglass P. Idiopathic dilated cardiomyopathy: a common but mystifying cause of heart failure. Cleve Clin J Med. 2002;69(6):481–7.CrossRefPubMed Mohan SB, Parker M, Wehbi M, Douglass P. Idiopathic dilated cardiomyopathy: a common but mystifying cause of heart failure. Cleve Clin J Med. 2002;69(6):481–7.CrossRefPubMed
14.
go back to reference Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119.CrossRefPubMed Galiè N, Humbert M, Vachiery JL, Gibbs S, Lang I, Torbicki A, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016;37(1):67–119.CrossRefPubMed
15.
go back to reference Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84:416–20.CrossRefPubMed Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84:416–20.CrossRefPubMed
16.
go back to reference de Groote P, Millaire A, Foucher-Hossein C, Nugue O, Marchandise X, Ducloux G, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998;32:948–54.CrossRefPubMed de Groote P, Millaire A, Foucher-Hossein C, Nugue O, Marchandise X, Ducloux G, et al. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol. 1998;32:948–54.CrossRefPubMed
17.
go back to reference Fantoni C, Kawabata M, Massaro R, Regoli F, Raffa S, Arora V, et al. Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: a detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system. J Cardiovasc Electrophysiol. 2005;16:112–9.CrossRefPubMed Fantoni C, Kawabata M, Massaro R, Regoli F, Raffa S, Arora V, et al. Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: a detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system. J Cardiovasc Electrophysiol. 2005;16:112–9.CrossRefPubMed
18.
go back to reference Ciuraszkiewicz K, Janion M, Dudek D, Gawor Z. Plasma B-type natriuretic peptide as a marker of myocardial asynchrony. Cardiology. 2009;113:193–7.CrossRefPubMed Ciuraszkiewicz K, Janion M, Dudek D, Gawor Z. Plasma B-type natriuretic peptide as a marker of myocardial asynchrony. Cardiology. 2009;113:193–7.CrossRefPubMed
19.
go back to reference Rickard J, Kumbhani DJ, Gorodeski EZ, Baranowski B, Wazni O, Martin DO, et al. Cardiac resynchronization therapy in non-left bundle branch block morphologies. Pacing Clin Electrophysiol. 2010;33:590–5.CrossRefPubMed Rickard J, Kumbhani DJ, Gorodeski EZ, Baranowski B, Wazni O, Martin DO, et al. Cardiac resynchronization therapy in non-left bundle branch block morphologies. Pacing Clin Electrophysiol. 2010;33:590–5.CrossRefPubMed
Metadata
Title
Effects of ventricular conduction block patterns on mortality in hospitalized patients with dilated cardiomyopathy: a single-center cohort study
Authors
Xiaoping Li
Rong Luo
Wei Fang
Xiaolei Xu
Guodong Niu
Yixian Xu
Michael Fu
Wei Hua
Xiushan Wu
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2016
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-016-0313-4

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