Division of Cardiology, Department of Medicine, Karolinska Institutet, Norrbacka S1:02, Eugeniavägen 27-31, 171 76 Stockholm, Sweden.
Department of Cardiology, Karolinska Universitetssjukhuset, Stockholm, Sweden.
Europace. 2023 Jul 4;25(7). doi: 10.1093/europace/euad192.
Left bundle branch block (LBBB) might be the first finding of cardiovascular diseases but also the prerequisite for cardiac resynchronization therapy (CRT) in heart failure (HF) with reduced ejection fraction (HFrEF). The prognosis for patients with LBBB and the implications of CRT in an unselected real-world setting are the focus of our study.
A central electrocardiogram (ECG) database and national registers have been screened to identify patients with LBBB. Predictors of HF and the use of CRT were identified with Cox models. The hazard ratios (HRs) of death, cardiovascular death (CVD), and HF hospitalization (HFH) were estimated according to CRT use. Of 5359 patients with LBBB and QRS > 150 ms, median age 76 years, 36% were female. At the time of index ECG, 41% had a previous history of HF and 27% developed HF. Among 1053 patients with a class I indication for CRT, only 60% received CRT with a median delay of 137 days, and it was associated with a lower risk of death [HR: 0.45, 95% confidence interval (CI): 0.36-0.57], CVD (HR: 0.47, 95% CI: 0.35-0.63), and HFH (HR: 0.56, 95% CI: 0.48-0.66). The age of over 75 years and the diagnosis of dementia and chronic obstructive pulmonary disease were predictors of CRT non-use, while having a pacing/defibrillator device independently predicted CRT use.
In an unselected LBBB population, CRT is underused but of great value for HF patients. Therefore, it is crucial to find ways of better implementing and understanding CRT utilization and characteristics that influence the management of our patients.
左束支传导阻滞（LBBB）可能是心血管疾病的首发表现，也是射血分数降低的心力衰竭（HFrEF）患者心脏再同步治疗（CRT）的前提。本研究重点关注 LBBB 患者的预后以及 CRT 在未选择的真实世界环境中的应用意义。
筛选了中心心电图（ECG）数据库和国家登记处，以确定 LBBB 患者。使用 Cox 模型确定心力衰竭和 CRT 的预测因素。根据 CRT 的使用情况，估计死亡、心血管死亡（CVD）和心力衰竭住院（HFH）的风险比（HR）。在 5359 例 QRS>150ms 的 LBBB 患者中，中位年龄为 76 岁，36%为女性。在指数 ECG 时，41%的患者有心力衰竭病史，27%的患者发生心力衰竭。在 1053 例有 CRT Ⅰ类适应证的患者中，只有 60%接受了 CRT，中位延迟时间为 137 天，且死亡率降低[HR：0.45，95%置信区间（CI）：0.36-0.57]、CVD（HR：0.47，95%CI：0.35-0.63）和 HFH（HR：0.56，95%CI：0.48-0.66）。年龄>75 岁、痴呆和慢性阻塞性肺疾病的诊断是 CRT 未使用的预测因素，而植入起搏器/除颤器则独立预测 CRT 的使用。
在未选择的 LBBB 人群中，CRT 的使用不足，但对心力衰竭患者具有重要价值。因此，找到更好地实施和理解 CRT 应用以及影响患者管理的 CRT 使用特征的方法至关重要。
