title: Prediction of mortality in patients with right bundle branch block referred for pharmacologic stress echocardiography.
abstract: Right bundle branch block (RBBB) is independently associated with all-cause mortality in patients referred for noninvasive evaluation of coronary artery disease. However, further stratification of risk in these patients has not been specifically addressed. The aim of this study was to risk stratify patients with RBBB who were referred for stress echocardiography. The study population was comprised of 343 patients (267 men; age 66 +/- 9 years) with RBBB who underwent pharmacologic stress echocardiography (231 dipyridamole, 112 dobutamine) for evaluation of suspected or known coronary artery disease. Overall mortality was the only end point. Stress echocardiography was positive for ischemia in 109 patients (32%). During follow-up (38 +/- 32 months), 36 deaths occurred. Seventy-three patients underwent revascularization and were censored. Ischemia at stress echocardiography (hazard ratio [HR] 2.9, 95% confidence interval [CI] 1.5 to 5.5, p=0.002), left anterior fascicular block (LAFB) (HR 2.8, 95% CI 1.4 to 5.6, p = 0.002), age >65 years (HR 2.1, 95% CI 1.0 to 4.3, p=0.047), and wall motion score index at rest (HR 2.5, 95% CI 1.0 to 6.5, p=0.057) were multivariate predictors of mortality. On the basis of stress echocardiographic result and presence and/or absence of LAFB, 3 levels of risk were identified: (1) low-risk, in cases of no ischemia and no LAFB (49% of the entire study population); (2) intermediate-risk, in cases of ischemia or LAFB only; and (3) high-risk, in cases of ischemia and LAFB. Clinical data, electrocardiography at rest, and stress echocardiographic results can provide effective stratification of risk in patients with RBBB.
authors.affiliation: Division of Cardiology, Lucca Hospital, Lucca, Italy. lacortig@tin.it
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Riccardo
authors.initials: R
authors.lastname: Bigi
authors.forename: Guido
authors.initials: G
authors.lastname: Gigli
authors.forename: Claudio
authors.initials: C
authors.lastname: Dodi
authors.forename: Egidio
authors.initials: E
authors.lastname: Mariotti
authors.forename: Claudio
authors.initials: C
authors.lastname: Coletta
authors.forename: Costantino
authors.initials: C
authors.lastname: Astarita
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000367:Age Factors; D000368:Aged; D002037:Bundle-Branch Block / Q000401:mortality*; D002316:Cardiotonic Agents; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality; D004176:Dipyridamole; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D009200:Myocardial Contraction; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D018570:Risk Assessment; D016019:Survival Analysis; D014665:Vasodilator Agents
chemical_list: D002316:Cardiotonic Agents; D014665:Vasodilator Agents; D004280:Dobutamine; D004176:Dipyridamole