Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort.
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.
Huvelle
Etienne
E
CIC-INSEM-CHU, Nancy, Hôpital Jeanne d'Arc, BP 90303, 54201 Toul Cedex, France.
Fay
Renaud
R
Alla
François
F
Cohen Solal
Alain
A
Mebazaa
Alexandre
A
Zannad
Faiez
F
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