title: Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort.
abstract: OBJECTIVE
  In patients with chronic heart failure (CHF), left bundle branch block (LBBB) is associated with an increased risk of cardiovascular mortality. We aimed to investigate the association of LBBB with short- and long-term outcome in patients discharged after a de novo episode of acute heart failure (AHF) or AHF complicating a mild CHF.
  
  
  RESULTS
  Patients with no history of New York Heart Association class III and IV CHF, who were admitted for a severe AHF episode and enrolled in the prospective observational EFICA study (n = 403), were included. Left bundle branch block prevalence was 16%. Patients with LBBB had a higher prevalence of dilated cardiomyopathy (23 vs. 10%, P < 0.005), a higher percentage of AHF episodes without identified precipitating factor (15 vs. 2%, P < 0.001), and were less likely to present increased markers of cardiac injury (41 vs. 56%, P = 0.04). The 4-week mortality was 24.8% with no difference between LBBB and no LBBB patients. Left bundle branch block was however an independent predictor of 1-year mortality in the 4-week survivors [hazards ratio (95% confidence interval) = 2.01 (1.12-3.64), P = 0.02].
  
  
  CONCLUSIONS
  Long-term outcome of patients surviving a severe episode of de novo AHF or AHF complicating a mild CHF is worsened by LBBB. These patients may constitute a subgroup at high risk in whom specific therapeutic solutions should be investigated.
authors.affiliation: CIC-INSEM-CHU, Nancy, Hôpital Jeanne d'Arc, BP 90303, 54201 Toul Cedex, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Huvelle
authors.forename: Renaud
authors.initials: R
authors.lastname: Fay
authors.forename: François
authors.initials: F
authors.lastname: Alla
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen Solal
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000401:mortality*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors