The prognostic significance of bundle branch block in high-risk chronic stable vascular disease patients: a report from the HOPE trial.
OBJECTIVE
The prognostic significance of left and right bundle branch block (LBBB and RRBB) in patients with chronic stable cardiovascular (CV) disease is not well characterized and was evaluated in the Heart Outcomes Prevention Evaluation (HOPE) study cohort.


METHODS
Observational analysis of data prospectively collected in the HOPE trial.


METHODS
HOPE was a multicenter, international trial, which evaluated ramipril and vitamin E in 9,541 patients aged > or = 55 years with CV disease or diabetes with > or = 1 CV risk factor(s) but without heart failure (HF) or known left ventricular systolic dysfunction. Follow-up extended for a median of 4.5 years. Electrocardiograms were obtained at baseline in all study participants and were read centrally.


METHODS
Major CV events (defined as CV death, myocardial infarction, or stroke), heart failure, CV death, all-cause death, and sudden death.


RESULTS
Baseline LBBB was present in 246 (2.6%) patients and was associated with increased risk for major CV events (HR = 1.54; 95% CI, 1.18-2.02), CV death (HR 2.29; 95% CI, 1.63-3.20), heart failure (HR 2.99; 95% CI, 2.31-3.87), sudden death (HR 3.17; 95% CI, 2.13-4.73), and all-cause death (HR = 2.10; 95% CI, 1.59-2.77). In multivariate models, LBBB remained an independent predictor of heart failure, sudden death, CV death, and all-cause death (P < or = 0.002 for all). Baseline RBBB was present in 428 (4.5%) of patients and was not associated with increased CV risk.


CONCLUSIONS
In patients with stable chronic CV disease, LBBB but not RBBB is an independent predictor of heart failure, sudden death, CV death, and all-cause death.
Sumner
Glen
G
Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
Salehian
Omid
O
Yi
Qilong
Q
Healey
Jeff
J
Mathew
James
J
Al-Merri
Khalid
K
Al-Nemer
Khaled
K
Mann
J F E
JF
Dagenais
Gilles
G
Lonn
Eva
E
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002037:Bundle-Branch Block / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D002908:Chronic Disease; D003645:Death, Sudden / Q000209:etiology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D009656:North America; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017257:Ramipril / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D014810:Vitamin E / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D014810:Vitamin E; D017257:Ramipril