title: Ventricular conduction abnormalities as predictors of long-term survival in acute de novo and decompensated chronic heart failure.
abstract: OBJECTIVE
  Data on the prognostic role of left and right bundle branch blocks (LBBB and RBBB), and nonspecific intraventricular conduction delay (IVCD; QRS ≥ 110 ms, no BBB) in acute heart failure (AHF) are controversial. Our aim was to investigate electrocardiographic predictors of long-term survival in patients withde novoAHF and acutely decompensated chronic heart failure (ADCHF).
  
  
  RESULTS
  We analysed the admission electrocardiogram of 982 patients from a multicenter European cohort of AHF with 3.9 years' mean follow-up. Half (51.5%,n= 506) of the patients hadde novoAHF. LBBB, and IVCD were more common in ADCHF than inde novoAHF: 17.2% vs. 8.7% (P< 0.001) and 20.6% vs. 13.2% (P= 0.001), respectively, and RBBB was almost equally common (6.9% and 8.1%;P= 0.5), respectively. Mortality during the follow-up was higher in patients with RBBB (85.4%) and IVCD (73.7%) compared with patients with normal ventricular conduction (57.0%);P< 0.001 for both. The impact of RBBB on prognosis was prominent inde novoAHF (adjusted HR 1.93, 1.03-3.60;P= 0.04), and IVCD independently predicted death in ADCHF (adjusted HR 1.79, 1.28-2.52;P= 0.001). Both findings were pronounced in patients with reduced ejection fraction. LBBB showed no association with increased mortality in either of the subgroups. The main results were confirmed in a validation cohort of 1511 AHF patients with 5.9 years' mean follow-up.
  
  
  CONCLUSIONS
  Conduction abnormalities predict long-term survival differently inde novoAHF and ADCHF. RBBB predicts mortality inde novoAHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.
authors: Heart and Lung Center, Cardiology Helsinki University Hospital Finland.
authors: Heli
authors: H
authors: Tolppanen
authors: Department of Medicine Helsinki University Hospital Finland.
authors: Krista
authors: K
authors: Siirila-Waris
authors: Division of Emergency Care, Department of Medicine Helsinki University Hospital Finland.
authors: Veli-Pekka
authors: VP
authors: Harjola
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland.
authors: David
authors: D
authors: Marono
authors: Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic.
authors: Jiri
authors: J
authors: Parenica
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland.
authors: Philipp
authors: P
authors: Kreutzinger
authors: Heart and Lung Center, Cardiology Helsinki University Hospital Finland.
authors: Tuomo
authors: T
authors: Nieminen
authors: Cardiology Department Faculty Hospital Brno Czech Republic.
authors: Marie
authors: M
authors: Pavlusova
authors: Department of Medicine Helsinki University Hospital Finland.
authors: Tuukka
authors: T
authors: Tarvasmaki
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland.
authors: Raphael
authors: R
authors: Twerenbold
authors: Department of Medicine Helsinki University Hospital Finland.
authors: Jukka
authors: J
authors: Tolonen
authors: Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic.
authors: Roman
authors: R
authors: Miklik
authors: Heart and Lung Center, Cardiology Helsinki University Hospital Finland.
authors: Markku S
authors: MS
authors: Nieminen
authors: Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center, Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic.
authors: Jindrich
authors: J
authors: Spinar
authors: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB) University Hospital Basel Switzerland.
authors: Christian
authors: C
authors: Mueller
authors: Heart and Lung Center, Cardiology Helsinki University Hospital Finland.
authors: Johan
authors: J
authors: Lassus
keywords: Acute heart failure; Bundle branch block; Prognosis; Ventricular conduction; de novo