Thein Anna-Sophie, Dixit Shalini, Soliman Elsayed Z, Heckbert Susan R, Psaty Bruce M, Gottdiener John, Marcus Gregory M
Division of Cardiology, Department of Medicine, University of California, San Francisco.
Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
JAMA Netw Open. 2025 Aug 1;8(8):e2525801. doi: 10.1001/jamanetworkopen.2025.25801.
Left bundle branch block (LBBB) might play a causative role in the progression to heart failure (HF), but the association of LBBB with HF in asymptomatic individuals with structurally normal hearts has not yet been investigated.
To examine the association of LBBB with the risk of HF in community-dwelling individuals.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study used data from 4 US sites participating in the Cardiovascular Health Study (1989-1990), collected from 1989 to 2013. Adults aged 65 years and older with a normal left ventricular ejection fraction (LVEF) and no history of HF at baseline were included. Data were analyzed from February 2018 to October 2024.
The presence of LBBB as confirmed by 12-lead electrocardiograms obtained on all participants at baseline.
Multivariable Cox proportional hazards models were used to estimate the associations of LBBB with the risk of incident HF, hospital admission for HF with reduced EF or HF with preserved EF, 5-year LVEF decline, and death.
Among 4541 individuals (mean [SD] age, 72.6 [5.5] years; 2697 female [59.4%]), 44 (1.0%) exhibited LBBB at baseline, and 1321 (29.1%) received a diagnosis of HF over a median (IQR) follow-up of 14.6 (8.4-18.3) years. In the adjusted model, those with baseline LBBB had an increased risk of incident HF (hazard ratio, 4.98; 95% CI, 2.18-11.39; P < .001) and greater odds of 5-year LVEF decline (odds ratio, 4.73; 95% CI, 1.70-13.70; P = .003), but no statistically significant increased risk of death was observed (hazard ratio, 1.39; 95% CI, 0.99-1.94; P = .05).
In this cohort study of individuals with structurally normal hearts, LBBB was associated with an increased risk of HF and a decrease in LVEF, suggesting that LBBB could be a potential target for early interventions to prevent deterioration of cardiac function and, ultimately, progression to HF.
左束支传导阻滞（LBBB）可能在心力衰竭（HF）的进展中起致病作用，但LBBB与心脏结构正常的无症状个体的HF之间的关联尚未得到研究。
研究社区居住个体中LBBB与HF风险的关联。
设计、设置和参与者：这项纵向队列研究使用了来自参与心血管健康研究（1989 - 1990年）的美国4个地点的数据，收集时间为1989年至2013年。纳入了基线时左心室射血分数（LVEF）正常且无HF病史的65岁及以上成年人。数据于2018年2月至2024年10月进行分析。
通过所有参与者在基线时获得的12导联心电图确认的LBBB的存在。
使用多变量Cox比例风险模型来估计LBBB与HF发病风险、因射血分数降低的HF或射血分数保留的HF住院、5年LVEF下降以及死亡之间的关联。
在4541名个体（平均[标准差]年龄，72.6[5.5]岁；2697名女性[59.4%]）中，44名（1.0%）在基线时表现出LBBB，在中位（四分位间距）随访14.6（8.4 - 18.3）年期间，1321名（29.1%）被诊断为HF。在调整模型中，基线时存在LBBB的个体发生HF的风险增加（风险比，4.98；95%置信区间，2.18 - 11.39；P < .001），5年LVEF下降的几率更高（优势比，4.73；95%置信区间，1.70 - 13.70；P = .003），但未观察到死亡风险有统计学意义的增加（风险比，1.39；95%置信区间，0.99 - 1.94；P = .05）。
在这项针对心脏结构正常个体的队列研究中，LBBB与HF风险增加和LVEF降低相关，表明LBBB可能是早期干预的潜在靶点，以防止心脏功能恶化并最终预防进展为HF。
