Bundle branch block patterns, age, renal dysfunction, and heart failure mortality.
BACKGROUND
The determinants of bundle block patterns and their relationship to mortality in heart failure patients is not completely understood.


METHODS
We evaluated 2907 consecutive patients admitted to an intensive care unit with decompensated heart failure over 8 years. Clinical and echocardiographic factors were analyzed using multivariate techniques. All-cause mortality was available on greater than 99.0% of patients at a median of 23 months after discharge.


RESULTS
Right and left bundle branch blocks occurred in 211 (7.3%) and 386 (13.2%), p<0.0001. Older age, decreased left ventricular ejection fraction, and renal dysfunction were all found to be independently associated with bundle branch block patterns. Mortality rates for the subgroups of QRS<120 ms, right bundle branch block and left bundle branch block, over a mean follow-up of 23.4+/-2.6 months were 46.1%, 56.8% and 57.7%, p<0.0001 for comparison of QRS<120 ms versus either bundle pattern. Cox proportional hazards model adjusting for age, sex, ejection fraction, and renal function demonstrated graded decrements in survival in those with QRS<120 ms, right bundle branch block and left bundle branch block, p=0.03.


CONCLUSIONS
In patients hospitalized with severe heart failure, age, left ventricular dysfunction, and renal dysfunction are associated with bundle branch block patterns. When controlling for these factors, bundle branch block patterns are independently associated with slightly higher all cause mortality after discharge.
Division of Cardiology, William Beaumont Hospital, Beaumont Health Center, 4949 Coolidge Highway, Royal Oak, MI 48073, United States. pmc975@yahoo.com
Peter A
PA
McCullough
Sohail A
SA
Hassan
Vinay
V
Pallekonda
Keisha R
KR
Sandberg
David B
DB
Nori
Sandeep S
SS
Soman
Sonali
S
Bhatt
Michael P
MP
Hudson
W Douglas
WD
Weaver
D000367:Age Factors; D002037:Bundle-Branch Block / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D003404:Creatinine / Q000097:blood*; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000209:etiology / Q000401:mortality*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
D003404:Creatinine