Department of Medicine, University of Toronto, Toronto, Canada.
Int J Cardiol. 2011 Jan 21;146(2):213-8. doi: 10.1016/j.ijcard.2010.01.012. Epub 2010 Mar 3.
The prognostic value of left and right bundle branch blocks (LBBB and RBBB) in hospitalized heart failure (HF) patients is unclear. We sought to determine the prognostic value of bundle branch blocks in patients hospitalized with heart failure.
The associations of BBB type with death, HF hospitalizations or cardiovascular hospitalizations over a five year follow-up were examined within the EFFECT study of hospitalized patients fulfilling the Framingham criteria for acute heart failure. Multinomial logistic regression was used to determine associations with BBB type, and survival was assessed using multiple Cox regression analysis.
Among 9082 patients (16.3% with LBBB; 7.2% with RBBB), LBBB was independently associated with lower systolic pressure, tachycardia and hyponatremia (odds ratio [OR] of 0.93 per 10 mmHg, 1.04 per 10 beats/min, and 0.84 per 10 mmol/L, respectively). Men and diabetics (OR of 2.11 and 1.35, respectively) had greater odds of RBBB. After multiple covariate adjustment (n=7319), patients with LBBB had increased risk of HF hospitalization with adjusted hazard ratio [HR] of 1.32 (95% CI; 1.20-1.46, p<0.001) and cardiovascular hospitalization with HR of 1.13 (95% CI; 1.04-1.23, p=0.003). LBBB was associated with increased mortality with adjusted HR of 1.10 (95% CI, 1.02-1.18; p=0.011) in 7910 analysed patients. RBBB did not predict significantly increased risk of either death or hospitalization.
Heart failure patients presenting with LBBB had greater clinical severity of heart failure at presentation and greater risk of death and hospitalization for heart failure or cardiovascular disease than those without BBB. In contrast, RBBB did not independently predict worse outcomes.
左束支传导阻滞（LBBB）和右束支传导阻滞（RBBB）在住院心力衰竭（HF）患者中的预后价值尚不清楚。我们旨在确定束支传导阻滞在心力衰竭住院患者中的预后价值。
在符合急性心力衰竭Framingham 标准的住院患者 EFFECT 研究中，检查了 BBB 类型与五年随访期间死亡、HF 住院或心血管住院之间的相关性。多变量逻辑回归用于确定与 BBB 类型的相关性，使用多 Cox 回归分析评估生存率。
在 9082 名患者中（16.3%为 LBBB；7.2%为 RBBB），LBBB 与较低的收缩压、心动过速和低钠血症独立相关（每降低 10mmHg 的比值比 [OR]为 0.93，每增加 10 次/分钟的 OR 为 1.04，每降低 10mmol/L 的 OR 为 0.84）。男性和糖尿病患者（OR 分别为 2.11 和 1.35）发生 RBBB 的可能性更大。在进行多项协变量调整（n=7319）后，LBBB 患者 HF 住院的风险增加，调整后的危险比 [HR]为 1.32（95%可信区间为 1.20-1.46，p<0.001），心血管住院的 HR 为 1.13（95%可信区间为 1.04-1.23，p=0.003）。在分析的 7910 名患者中，LBBB 与死亡率增加相关，调整后的 HR 为 1.10（95%可信区间，1.02-1.18；p=0.011）。RBBB 并未显著预测死亡或住院的风险增加。
出现 LBBB 的心力衰竭患者在就诊时心力衰竭的临床严重程度更高，并且死于心力衰竭或心血管疾病以及因心力衰竭或心血管疾病住院的风险更高，而无 BBB 的患者则没有这种风险。相比之下，RBBB 不能独立预测预后不良。
