Exercise left ventricular ejection fraction predicts events in right bundle branch block. (3rd March 2016)

• Record Type: Journal Article
• Authors: Peteiro, Jesús; Bouzas-Mosquera, Alberto; Broullón, Javier; Yañez, Juan; Martinez, Dolores; Vazquez, Jose Manuel
• Is Part Of: Scandinavian cardiovascular journal. Volume 50:Number 2(2016:Apr.)
• Page Start: 108
• Page End: 113
• Publication Date: 2016-03-03
• Subjects: Exercise echocardiography -- prognosis -- right bundle branch block; Cardiovascular system -- Diseases -- Periodicals; 617.41
• DOI: 10.3109/14017431.2015.1118529
• Languages: English
• ISSNs: 1401-7431

Abstract

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. Design 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.