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Clinical Research in Cardiology

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18.09.2022 | Original Paper

The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis

verfasst von: Oriol Aguiló, Xavier Castells, Òscar Miró, Christian Mueller, Ovidiu Chioncel, Joan Carles Trullàs

Erschienen in: Clinical Research in Cardiology | Ausgabe 8/2023

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Abstract

Aims

The aim of this study was to conduct a meta-analysis of prospective studies assessing the relationship between bundle branch block (BBB) or wide QRS and risk of all-cause mortality in patients with acute heart failure (AHF).

Methods and results

We searched the PubMed, Scopus and Web of Science database from inception to February 2022 to identify single centre or multicentre studies including a minimum of 400 patients and assessing the association between BBB or wide QRS and mortality in patients with AHF. Study-specific hazard ratio (HR) estimates were combined using a random-effects meta-analysis. Two meta-analyses were performed: (1) grouping by conduction disturbance and follow-up length and, (2) using the results from the longest follow-up for each study and grouping by the type of BBB. The meta-analysis included 21 publications with a total of 116,928 patients. Wide QRS (considering right (RBBB) and left (LBBB) altogether) was associated with a significant increment in the risk of all-cause mortality (pooled adjusted HR 1.112, 95% CI 1.065–1.160). The increased risk of death was also present when LBBB (HR 1.121, 95% CI 1.042–1.207) and RBBB (HR 1.187, 95% CI 1.045–1.348) were considered individually. There was no difference in risk between LBBB and RBBB (P for interaction = 0.533). Other outcomes including sudden death, rehospitalization and a combination of cardiovascular death or rehospitalization were also increased in patients with BBB or wide QRS.

Conclusions

This meta-analysis suggests a modest increase in the risk of all-cause mortality among patients with AHF and BBB or wide QRS, irrespective of the type of BBB.

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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine SA (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 42(48):4901. https://doi.org/10.1093/eurheartj/ehab670CrossRefPubMed

Butler J, Yang M, Manzi MA, Hess GP, Patel MJ, Rhodes T, Givertz MM (2019) Clinical course of patients with worsening heart failure with reduced ejection fraction. J Am Coll Cardiol 73(8):935–944. https://doi.org/10.1016/j.jacc.2018.11.049CrossRefPubMed

Kurmani S, Squire I (2017) Acute heart failure: definition, classification and epidemiology. Curr Heart Fail Rep 14(5):385–392. https://doi.org/10.1007/s11897-017-0351-yCrossRefPubMedPubMedCentral

Sinnenberg L, Givertz MM (2020) Acute heart failure. Trends Cardiovasc Med 30(2):104–112. https://doi.org/10.1016/j.tcm.2019.03.007CrossRefPubMed

Miró Ò, López-Díez MP, Cardozo C, Moreno LA, Gil V, Jacob J, Herrero P, Llorens P, Escoda R, Richard F, Alquézar-Arbé A, Masip J, García-Álvarez A, Martín-Sánchez FJ, ICA-SEMES group (2022) Impact of hospital and emergency department structural and organizational characteristics on outcomes of acute heart failure. Rev Esp Cardiol (Engl Ed). 75(1):39–49. https://doi.org/10.1016/j.rec.2020.11.022CrossRefPubMed

Miró Ò, Aguirre A, Herrero P, Jacob J, Martín-Sánchez FJ, Llorens P (2015) PAPRICA-2 study: role of precipitating factor of an acute heart failure episode on intermediate term prognosis. Med Clin (Barc) 145(9):385–389. https://doi.org/10.1016/j.medcli.2015.01.014CrossRefPubMed

Madias JE (2007) The resting electrocardiogram in the management of patients with congestive heart failure: established applications and new insights. Pacing Clin Electrophysiol 30(1):123–128. https://doi.org/10.1111/j.1540-8159.2007.00586.xCrossRefPubMed

Shenkman HJ, Pampati V, Khandelwal AK, McKinnon J, Nori D, Kaatz S, Sandberg KR, McCullough PA (2002) Congestive heart failure and QRS duration: establishing prognosis study. Chest 122(2):528–534. https://doi.org/10.1378/chest.122.2.528CrossRefPubMed

Sandhu R, Bahler RC (2004) Prevalence of QRS prolongation in a community hospital cohort of patients with heart failure and its relation to left ventricular systolic dysfunction. Am J Cardiol 93(2):244–246. https://doi.org/10.1016/j.amjcard.2003.09.053CrossRefPubMed

10.

Kashani A, Barold SS (2005) Significance of QRS complex duration in patients with heart failure. J Am Coll Cardiol 46(12):2183–2192. https://doi.org/10.1016/j.jacc.2005.01.071CrossRefPubMed

11.

Fabiszak T, Łach P, Ratajczak J, Koziński M, Krupa W, Kubica J (2020) Influence of QRS duration and axis on response to cardiac resynchronization therapy in chronic heart failure with reduced left ventricular ejection fraction: a single center study including patients with left bundle branch block. Cardiol J 27(5):575–582. https://doi.org/10.5603/CJ.a2018.0138CrossRefPubMedPubMedCentral

12.

Park SJ, On YK, Byeon K, Kim JS, Choi JO, Choi DJ, Ryu KH, Jeon ES (2013) Short- and long-term outcomes depending on electrical dyssynchrony markers in patients presenting with acute heart failure: clinical implication of the first-degree atrioventricular block and QRS prolongation from the Korean Heart Failure registry. Am Heart J 165(1):57-64.e2. https://doi.org/10.1016/j.ahj.2012.10.009CrossRefPubMed

13.

Breidthardt T, Christ M, Matti M, Schrafl D, Laule K, Noveanu M, Boldanova T, Klima T, Hochholzer W, Perruchoud AP, Mueller C (2007) QRS and QTc interval prolongation in the prediction of long-term mortality of patients with acute destabilised heart failure. Heart 93(9):1093–1097. https://doi.org/10.1136/hrt.2006.102319CrossRefPubMedPubMedCentral

14.

Lund LH, Jurga J, Edner M, Benson L, Dahlström U, Linde C, Alehagen U (2013) Prevalence, correlates, and prognostic significance of QRS prolongation in heart failure with reduced and preserved ejection fraction. Eur Heart J 34(7):529–539. https://doi.org/10.1093/eurheartj/ehs305CrossRefPubMed

15.

Gouda P, Brown P, Rowe BH, McAlister FA, Ezekowitz JA (2016) Insights into the importance of the electrocardiogram in patients with acute heart failure. Eur J Heart Fail 18(8):1032–1040. https://doi.org/10.1002/ejhf.561CrossRefPubMed

16.

Harjola VP, Follath F, Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Hochadel M, Komajda M, Lopez-Sendon JL, Ponikowski P, Tavazzi L (2010) Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 12(3):239–248. https://doi.org/10.1093/eurjhf/hfq002CrossRefPubMed

17.

Václavík J, Špinar J, Vindiš D, Vítovec J, Widimský P, Číhalík Č, Linhart A, Málek F, Táborský M, Dušek L, Jarkovský J, Fedorco M, Felšöci M, Miklík R, Pařenica J (2014) ECG in patients with acute heart failure can predict in-hospital and long-term mortality. Intern Emerg Med 9(3):283–291. https://doi.org/10.1007/s11739-012-0862-1CrossRefPubMed

18.

Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, Campana C, Perini G, Deorsola A, Masotti G, Tavazzi L, Maggioni AP, Italian Network on Congestive Heart Failure Investigators (2002) 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 143(3):398–405. https://doi.org/10.1067/mhj.2002.121264CrossRefPubMed

19.

Baldasseroni S, Gentile A, Gorini M, Marchionni N, Marini M, Masotti G, Porcu M, Maggioni AP, Italian Network on Congestive Heart Failure Investigators (2003) 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 4(9):607–613CrossRefPubMed

20.

Wang NC, Maggioni AP, Konstam MA, Zannad F, Krasa HB, Burnett JC Jr, Grinfeld L, Swedberg K, Udelson JE, Cook T, Traver B, Zimmer C, Orlandi C, Gheorghiade M, Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators (2008) Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA 299(22):2656–2666. https://doi.org/10.1001/jama.299.22.2656CrossRefPubMed

21.

Abdel-Qadir HM, Tu JV, Austin PC, Wang JT, Lee DS (2011) Bundle branch block patterns and long-term outcomes in heart failure. Int J Cardiol 146(2):213–218. https://doi.org/10.1016/j.ijcard.2010.01.012CrossRefPubMed

22.

Lee JH, Park JJ, Cho Y, Oh IY, Yoo BS, Kim JJ, Kim KH, Kang SM, Baek SH, Jeon ES, Cho MC, Chae SC, Oh BH, Choi DJ (2019) Prognostic implication of ventricular conduction disturbance pattern in hospitalized patients with acute heart failure syndrome. Korean Circ J 49(7):602–611. https://doi.org/10.4070/kcj.2018.0290CrossRefPubMedPubMedCentral

23.

Tabrizi F, Englund A, Rosenqvist M, Wallentin L, Stenestrand U (2007) Influence of left bundle branch block on long-term mortality in a population with heart failure. Eur Heart J 28(20):2449–2455. https://doi.org/10.1093/eurheartj/ehm262CrossRefPubMed

24.

Barsheshet A, Leor J, Goldbourt U, Garty M, Schwartz R, Behar S, Luria D, Eldar M, Glikson M (2008) Effect of bundle branch block patterns on mortality in hospitalized patients with heart failure. Am J Cardiol 101(9):1303–1308. https://doi.org/10.1016/j.amjcard.2007.12.035CrossRefPubMed

25.

Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish-Farkash A, Eldar M, Glikson M (2011) Relation of bundle branch block to long-term (four-year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 107(4):540–544. https://doi.org/10.1016/j.amjcard.2010.10.007CrossRefPubMed

26.

Hong SJ, Oh J, Kang SM, Youn JC, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Chae SC, Oh BH, Choi DJ, Lee MM, Ryu KH, KorHF Registry (2012) Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: data from the Korean Heart Failure (KorHF) Registry. Int J Cardiol 157(3):416–418. https://doi.org/10.1016/j.ijcard.2012.03.155CrossRefPubMed

27.

Dzudie A, Milo O, Edwards C, Cotter G, Davison BA, Damasceno A, Mayosi BM, Mondo C, Ogah O, Ojji D, Sani MU, Sliwa K (2014) Prognostic significance of ECG abnormalities for mortality risk in acute heart failure: insight from the Sub-Saharan Africa Survey of Heart Failure (THESUS-HF). J Card Fail 20(1):45–52. https://doi.org/10.1016/j.cardfail.2013.11.005CrossRefPubMed

28.

Aguiló O, Trullàs JC, Wussler D, Llorens P, Conde-Martel A, López-Ayala P, Jacob J, Roca-Villanueva B, Gil V, Belkin M, Satué-Bartolomé JÁ, Mueller C, Miró Ò, INVESTIGATORS OF THE EAHFE, RICA AND BASEL-V REGISTRIES (2022) Prevalence, related factors and association of left bundle branch block with prognosis in patients with acute heart failure: a simultaneous analysis in 3 independent cohorts. J Card Fail. https://doi.org/10.1016/j.cardfail.2021.11.022CrossRefPubMed

29.

Huvelle E, Fay R, Alla F, Cohen Solal A, Mebazaa A, Zannad F (2010) Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort. Eur J Heart Fail 12(2):156–163. https://doi.org/10.1093/eurjhf/hfp180CrossRefPubMed

30.

Tolppanen H, Siirila-Waris K, Harjola VP, Marono D, Parenica J, Kreutzinger P, Nieminen T, Pavlusova M, Tarvasmaki T, Twerenbold R, Tolonen J, Miklik R, Nieminen MS, Spinar J, Mueller C, Lassus J (2016) Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure. ESC Heart Fail 3(1):35–43. https://doi.org/10.1002/ehf2.12068CrossRefPubMed

31.

Mueller C, Laule-Kilian K, Klima T, Breidthardt T, Hochholzer W, Perruchoud AP, Christ M (2006) Right bundle branch block and long-term mortality in patients with acute congestive heart failure. J Intern Med 260(5):421–428. https://doi.org/10.1111/j.1365-2796.2006.01703.xCrossRefPubMed

32.

Trullàs JC, Aguiló O, Mirò Ó, Díez-Manglano J, Carrera-Izquierdo M, Quesada-Simón MA, Álvarez-Rocha P, Llorens P, González-Franco Á, Montero-Pérez-Barquero M, RICA registry researchers (2022) Prevalence and impact on prognosis of right-bundle branch block in patients with acute heart failure: findings from the RICA registry. Rev Clin Esp (Barc). 222(5):272–280. https://doi.org/10.1016/j.rceng.2021.10.002CrossRefPubMed

33.

McCullough PA, Hassan SA, Pallekonda V, Sandberg KR, Nori DB, Soman SS, Bhatt S, Hudson MP, Weaver WD (2005) Bundle branch block patterns, age, renal dysfunction, and heart failure mortality. Int J Cardiol 102(2):303–308. https://doi.org/10.1016/j.ijcard.2004.10.008CrossRefPubMed

34.

Hawkins NM, Wang D, McMurray JJ, Pfeffer MA, Swedberg K, Granger CB, Yusuf S, Pocock SJ, Ostergren J, Michelson EL, Dunn FG, CHARM Investigators and Committees (2007) Prevalence and prognostic impact of bundle branch block in patients with heart failure: evidence from the CHARM programme. Eur J Heart Fail 9(5):510–517. https://doi.org/10.1016/j.ejheart.2006.11.006CrossRefPubMed

35.

Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, Rautaharju PM, van Herpen G, Wagner GS, Wellens H, American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology et al (2009) AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 53(11):976–981. https://doi.org/10.1016/j.jacc.2008.12.013CrossRefPubMed

36.

Willems JL, Robles de Medina EO, Bernard R, Coumel P, Fisch C, Krikler D, Mazur NA, Meijler FL, Mogensen L, Moret P (1985) Criteria for intraventricular conduction disturbances and pre-excitation. World Health Organizational/International Society and Federation for Cardiology Task Force Ad Hoc. J Am Coll Cardiol 5(6):1261–1275. https://doi.org/10.1016/s0735-1097(85)80335-1CrossRefPubMed

37.

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, Ioannidis JP, Straus S, Thorlund K, Jansen JP, Mulrow C, Catalá-López F, Gøtzsche PC, Dickersin K, Boutron I, Altman DG, Moher D (2015) The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 162(11):777–784. https://doi.org/10.7326/M14-2385CrossRefPubMed

38.

McInnes MDF, Moher D, Thombs BD, McGrath TA, Bossuyt PM, the PRISMA-DTA Group, Clifford T, Cohen JF, Deeks JJ, Gatsonis C, Hooft L, Hunt HA, Hyde CJ, Korevaar DA, Leeflang MMG, Macaskill P, Reitsma JB, Rodin R, Rutjes AWS, Salameh JP, Stevens A, Takwoingi Y, Tonelli M, Weeks L, Whiting P, Willis BH (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319(4):388–396. https://doi.org/10.1001/jama.2017.19163CrossRefPubMed

39.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRefPubMedPubMedCentral

40.

Xiong Y, Wang L, Liu W, Hankey GJ, Xu B, Wang S (2015) The prognostic significance of right bundle branch block: a meta-analysis of prospective cohort studies. Clin Cardiol 38(10):604–613. https://doi.org/10.1002/clc.22454CrossRefPubMedPubMedCentral

41.

Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, ESC Scientific Document Group (2022) ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: Developed by the Task Force on cardiac pacing and cardiac resynchronization therapy of the European Society of Cardiology (ESC) With the special contribution of the European Heart Rhythm Association (EHRA). Rev Esp Cardiol (Engl Ed). 75(5):430. https://doi.org/10.1016/j.rec.2022.04.004CrossRefPubMed

42.

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726. https://doi.org/10.1093/eurheartj/ehab368CrossRefPubMed

Titel: The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis
verfasst von: Oriol Aguiló
Xavier Castells
Òscar Miró
Christian Mueller
Ovidiu Chioncel
Joan Carles Trullàs
Publikationsdatum: 18.09.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 8/2023
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-022-02105-z

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The prognostic significance of bundle branch block in acute heart failure: a systematic review and meta-analysis

Abstract

Aims

Methods and results

Conclusions

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