title: Prevalence of potential candidates for biventricular pacing among patients with known coronary artery disease: a prospective registry from a single center.
abstract: New forms of ventricular pacing are increasingly studied as an option in the management of patients with heart failure. Coronary artery disease (CAD) is the most frequent cause of heart failure, and patients with complete left or right bundle branch block (LBBB and RBBB) and a reduced left ventricular ejection fraction (LVEF) are the best candidates for this new therapy. However, the prevalence of this clinical presentation is uncertain. During a 1-year period, 433 patients with documented CAD (mean age 64 +/- 10 years, 79% men) who were referred for myocardial perfusion imaging were prospectively studied. All patients underwent a 2-day stress-rest gated 99mTc-Tetrofosmin SPECT study with evaluation of resting LV enddiastolic (LVEDV) and endsystolic (LVESV) volumes and LVEF. The resting ECG was examined in all patients for the presence of complete LBBB or RBBB. Of the 433 patients with CAD 36 patients (8.3%) had LBBB (n = 14) or RBBB (n = 22) and a QRS width > 120 ms. These 36 patients were in general older and more frequently had diabetes and atrial fibrillation. Patients with LBBB or RBBB had a significantly lower LVEF (41 +/- 16% vs 48 +/- 14%, P < 0.01) and significantly higher LV volumes compared to patients without LBBB or RBBB (177 +/- 79 mL vs 131 +/- 53 mL, P < 0.001 for LVEDV and 116 +/- 76 mL vs 73 +/- 49 mL, P < 0.001 for LVESV). In total, 112/433 (26%) had an LVEF < or = 40%; 16 had also a LBBB or RBBB (3.7% of the whole population, 14% of the patients with a LVEF < or = 40%). Within the group of patients with a LVEF > or = 40%, patients with BBB had comparable LVEF (26 +/- 9% vs 30 +/- 8%, P = NS) but significantly higher LVEDV and LVESV (230 +/- 70 mL vs 190 +/- 64 mL, P < 0.05 for LVEDV and 170 +/- 65 mL vs 135 +/- 56 mL, P < 0.05 for LVESV). In this prospective registry 3.7% of all patients with known CAD had LBBB or RBBB in combination with a LVEF < or = 40%. This represented 14% of all patients with a LVEF > or = 40%. These limited numbers should be kept in mind when considering biventricular pacing as a new therapeutic options in patients with heart failure.
authors.affiliation: Department of Cardiology, Ghent University Hospital, Ghent, Belgium. johan.desutter@rug.ac.be
authors.forename: J
authors.initials: J
authors.lastname: De Sutter
authors.forename: P
authors.initials: P
authors.lastname: De Bondt
authors.forename: C
authors.initials: C
authors.lastname: Van de Wiele
authors.forename: W
authors.initials: W
authors.lastname: Fonteyne
authors.forename: R
authors.initials: R
authors.lastname: Dierckx
authors.forename: D
authors.initials: D
authors.lastname: Clement
authors.forename: R
authors.initials: R
authors.lastname: Tavernier
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002306:Cardiac Volume; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D018579:Patient Selection; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*
chemical_list: D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; C078700:technetium tc-99m tetrofosmin