title: Prognostic significance of left anterior hemiblock in patients with suspected coronary artery disease.
abstract: OBJECTIVE
  This study was designed to assess the functional and prognostic significance of left anterior hemiblock (LAHB) in patients with no history of myocardial infarction referred for dobutamine stress echocardiography (DSE).
  
  
  BACKGROUND
  The significance of isolated LAHB in patients with suspected coronary artery disease (CAD) is unclear.
  
  
  METHODS
  We studied 1,187 patients with suspected CAD and no history of myocardial infarction who underwent DSE and were followed for occurrence of cardiac death.
  
  
  RESULTS
  Left anterior hemiblock was detected on baseline electrocardiogram in 159 patients (13%). Ischemia occurred more frequently in patients with LAHB (43% vs. 33%, p = 0.02). During a mean follow-up of 5.0 +/- 2.5 years, 125 patients (11%) died of cardiac causes. The annual cardiac death rate was 4.9% in patients with LAHB and 1.9% for patients without (p < 0.0001). Patients with both LAHB and an abnormal DSE had the highest annual cardiac death rate (6.3%). In a Cox multivariable analysis, independent predictors of cardiac death were age, smoking, history of heart failure, diabetes, and ischemia. Left anterior hemiblock was independently associated with increased risk of cardiac death among patients with normal DSE (hazard ratio 1.8, 95% confidence interval 1.1 to 3.8) and in patients with abnormal DSE (hazard ratio 1.7, 95% confidence interval 1.1 to 2.7).
  
  
  CONCLUSIONS
  In patients with suspected CAD referred for stress testing, LAHB is associated with increased risk of cardiac death. This risk is persistent after adjustment for major clinical data and abnormalities on the stress echocardiogram. Therefore, isolated LAHB should not be considered a benign electrocardiographic abnormality in these patients.
authors.affiliation: Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Abdou
authors.initials: A
authors.lastname: Elhendy
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
authors.forename: Stefan
authors.initials: S
authors.lastname: Nelwan
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Guido
authors.initials: G
authors.lastname: Rocchi
authors.forename: Maarten L
authors.initials: ML
authors.lastname: Simoons
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*