title: Exercise left ventricular ejection fraction predicts events in right bundle branch block.
abstract: OBJECTIVE
  Interpretation of the electrocardiogram (ECG) during exercise is not easy in patients with right bundle branch block (RBBB). Also, the value of exercise echocardiography (ExE) for predicting outcome in them has not been addressed. We sought to assess its prognostic value in patients with RBBB and known/suspected coronary disease.
  
  
  METHODS
  Retrospective analysis of data on 703 patients with RBBB who were submitted to a clinically-indicated ExE. The end points were overall mortality and combined myocardial infarction and cardiovascular mortality.
  
  
  RESULTS
  During follow-up (4.1 ± 4.5 years) there were 130 deaths and 108 combined events. Independent predictors of combined events were history of coronary artery disease (hazard ratio [HR] = 2.37, 95% Confidence Interval [CI] = 1.24-4.52, p = 0.009) resting wall motion score index (HR = 2.14, 95% CI = 1.12-4.10, p = 0.02), metabolic equivalents (HR = 0.89, 95% CI = 0.93-0.97, p = 0.007), Δ in double product with exercise (HR = 0.96, 95% CI = 0.92-1.00, p = 0.036) and Δ in left ventricular ejection fraction (LVEF) with exercise (HR = 0.97, 95% CI = 0.94-0.99, p = 0.01). Neither positive clinical nor ECG exercise testing was predictive. Combined event rates were 3.3% in patients with ΔLVEF > 5%, 4.7% in those with ΔLVEF between 1-5% and 8.2% in those with no increase (Δ < 1%).
  
  
  CONCLUSIONS
  A decrease in LVEF during exercise is predictive of serious events in patients with RBBB.
authors.affiliation: a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
authors.forename: Jesús
authors.initials: J
authors.lastname: Peteiro
authors.affiliation: a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
authors.forename: Alberto
authors.initials: A
authors.lastname: Bouzas-Mosquera
authors.affiliation: b Department of Information Technology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Broullón
authors.affiliation: a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
authors.forename: Juan
authors.initials: J
authors.lastname: Yañez
authors.affiliation: a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
authors.forename: Dolores
authors.initials: D
authors.lastname: Martinez
authors.affiliation: a Department of Cardiology , Complejo Hospitalario Universitario de A Coruña (CHUAC), Universidad de A Coruña e Instituto de Investigacion Biomedica de A Coruña (INIBIC) , A Coruña , Spain ;
authors.forename: Jose Manuel
authors.initials: JM
authors.lastname: Vazquez
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D004562:Electrocardiography; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: Exercise echocardiography; prognosis; right bundle branch block