Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil.
Telehealth Network of Minas Gerais, Hospital das Clínicas and Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 110, Belo Horizonte, Minas Gerais 30130-100, Brazil.
J Electrocardiol. 2019 Nov-Dec;57S:S56-S60. doi: 10.1016/j.jelectrocard.2019.09.004. Epub 2019 Sep 12.
Left bundle branch block is recognized as a marker of higher risk of death, but the prognostic value of the right bundle branch block in the general population is still controversial. Our aim is to evaluate the risk of overall and cardiovascular mortality in patients with right (RBBB) and left bundle branch block (LBBB) in a large electronic cohort of Brazilian patients.
This observational retrospective study was developed with the database of digital ECGs from Telehealth Network of Minas Gerais, Brazil (TNMG). All ECGs performed from 2010 to 2017 in primary care patients over 16 years old were assessed. The electronic cohort was obtained by linking data from ECG exams (name, sex, date of birth, city of residence) and those from national mortality information system, using standard probabilistic linkage methods (FRIL: Fine-grained record linkage software, v.2.1.5, Atlanta, GA). Only the first ECG of each patient was considered. Clinical data were self-reported, and ECGs were interpreted manually by cardiologists and automatically by the Glasgow University Interpreter software. Hazard ratio (HR) for mortality was estimated using Cox regression.
From a dataset of 1,773,689 patients, 1,558,421 primary care patients over 16 years old underwent a valid ECG recording during 2010 to 2017. We excluded 17,359 patients that didn't have a valid QRS measure from the Glasgow program and 11,091 patients from the control group that had QRS equal or above 120 ms and were not RBBB or LBBB. Therefore, 1,529,971 were included (median age 52 [Q1:38; Q3:65] years; 40.2% were male). In a mean follow-up of 3.7 years, the overall mortality rate was 3.34%. RBBB was more frequent (2.42%) than LBBB (1.32%). In multivariate analysis, adjusting for sex, age and comorbidities, both patients with RBBB (HR 1.32; CI 95% 1.27-1.37) and LBBB (HR 1.69; CI 95% 1.62-1.76) had higher risk of overall mortality. Women with RBBB had an increased risk of all-cause death compared to men (p < 0.001). Cardiovascular mortality was higher in patients with LBBB (HR 1.77; CI 95% 1.55-2.01), but not for RBBB.
Patients with RBBB and LBBB had higher risk of overall mortality. Women with RBBB had more risk of all-cause death than men. LBBB was associated with higher risk of cardiovascular mortality.
左束支传导阻滞被认为是死亡风险较高的标志物，但右束支传导阻滞在普通人群中的预后价值仍存在争议。我们的目的是在巴西大型电子队列中评估患有右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）的患者的总死亡率和心血管死亡率的风险。
这项观察性回顾性研究是在巴西远程医疗网络（TNMG）的数字心电图数据库中进行的。评估了 2010 年至 2017 年期间在 16 岁以上的初级保健患者中进行的所有心电图。通过使用标准概率链接方法（FRIL：细粒度记录链接软件，v.2.1.5，亚特兰大，GA），将来自心电图检查（姓名、性别、出生日期、居住城市）和国家死亡率信息系统的数据链接起来，获得电子队列。仅考虑每位患者的第一次心电图。临床数据是自我报告的，心电图由心脏病专家手动和格拉斯哥大学解释器软件自动解释。使用 Cox 回归估计死亡率的风险比（HR）。
从 1773689 名患者的数据集中，2010 年至 2017 年期间，有 1558421 名 16 岁以上的初级保健患者进行了有效的心电图记录。我们排除了 17359 名格拉斯哥程序中没有有效 QRS 测量值的患者和 11091 名对照组患者，这些患者的 QRS 等于或高于 120ms，并且不是 RBBB 或 LBBB。因此，共纳入 1529971 名患者（中位年龄 52[Q1：38；Q3：65]岁；40.2%为男性）。在平均 3.7 年的随访中，总死亡率为 3.34%。RBBB 比 LBBB 更常见（2.42%比 1.32%）。在多变量分析中，调整性别、年龄和合并症后，RBBB（HR 1.32；95%CI 1.27-1.37）和 LBBB（HR 1.69；95%CI 1.62-1.76）患者的整体死亡率风险均更高。与男性相比，RBBB 女性的全因死亡风险更高（p<0.001）。LBBB 患者的心血管死亡率更高（HR 1.77；95%CI 1.55-2.01），但 RBBB 患者则不然。
RBBB 和 LBBB 患者的整体死亡率风险较高。与男性相比，RBBB 女性的全因死亡风险更高。LBBB 与心血管死亡率升高相关。
