Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.

Cardiology Department Hospital Sanitas CIMA Barcelona Spain

Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark

Department of Emergency Medicine and Services Helsinki University Hospital and Helsinki University Helsinki Finland

Department of Intensive Care Consorci Sanitari Integral Barcelona Spain

Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic

Department of Internal Medicine Helsinki University Hospital and Helsinki University South Karelia Central Hospital Lappeenranta Finland

Heart and Lung Center Helsinki University Hospital and Helsinki University Helsinki Finland

Heart Center Päijät Häme Central Hospital Lahti Finland

Intensive Cardiac Care Unit Cardiology Department Hospital de la Santa Creu i Sant Pau Biomedical Research Institute IIB SantPau Universidad Autónoma de Barcelona Barcelona Spain

Intensive Cardiac Therapy Clinic Institute of Cardiology Warsaw Poland

000      

00000naa a2200000 a 4500

001      

bmc19035234

003      

CZ-PrNML

005      

20191015115121.0

007      

ta

008      

191007s2018 xxu f 000 0|eng||

009      

AR

024    7_

$a 10.1016/j.amjcard.2018.04.008 $2 doi

035    __

$a (PubMed)29778237

040    __

$a ABA008 $b cze $d ABA008 $e AACR2

041    0_

$a eng

044    __

$a xxu

100    1_

$a Tolppanen, Heli $u Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland; Heart Center, Päijät-Häme Central Hospital, Lahti, Finland. Electronic address: heli.tolppanen@helsinki.fi.

245    10

$a Prevalence, Temporal Evolution, and Impact on Survival of Ventricular Conduction Blocks in Patients With Acute Coronary Syndrome and Cardiogenic Shock / $c H. Tolppanen, T. Javanainen, J. Sans-Rosello, J. Parenica, T. Nieminen, M. Pavlusova, J. Masip, L. Köber, M. Banaszewski, A. Sionis, J. Spinar, VP. Harjola, R. Jurkko, J. Lassus, CardShock study investigators and for the GREAT Network,

520    9_

$a Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.

650    _2

$a akutní koronární syndrom $x komplikace $x mortalita $x patofyziologie $7 D054058

650    _2

$a dospělí $7 D000328

650    _2

$a senioři $7 D000368

650    _2

$a senioři nad 80 let $7 D000369

650    _2

$a blokáda Tawarova raménka $x epidemiologie $x etiologie $x patofyziologie $7 D002037

650    _2

$a koronární angiografie $7 D017023

650    12

$a elektrokardiografie $7 D004562

650    _2

$a ženské pohlaví $7 D005260

650    _2

$a následné studie $7 D005500

650    _2

$a převodní systém srdeční $x patofyziologie $7 D006329

650    _2

$a srdeční komory $x patofyziologie $7 D006352

650    _2

$a lidé $7 D006801

650    _2

$a mužské pohlaví $7 D008297

650    _2

$a lidé středního věku $7 D008875

650    _2

$a prevalence $7 D015995

650    _2

$a prospektivní studie $7 D011446

650    _2

$a kardiogenní šok $x komplikace $x mortalita $x patofyziologie $7 D012770

650    _2

$a míra přežití $x trendy $7 D015996

651    _2

$a Česká republika $x epidemiologie $7 D018153

655    _2

$a časopisecké články $7 D016428

655    _2

$a pozorovací studie $7 D064888

655    _2

$a práce podpořená grantem $7 D013485

700    1_

$a Javanainen, Tuija $u Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.

700    1_

$a Sans-Rosello, Jordi $u Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.

700    1_

$a Parenica, Jiri $u Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.

700    1_

$a Nieminen, Tuomo $u Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland; Department of Internal Medicine, Helsinki University Hospital and Helsinki University, South Karelia Central Hospital, Lappeenranta, Finland.

700    1_

$a Pavlusova, Marie $u Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.

700    1_

$a Masip, Josep $u Cardiology Department, Hospital Sanitas CIMA, Barcelona, Spain; Department of Intensive Care, Consorci Sanitari Integral, Barcelona, Spain.

700    1_

$a Köber, Lars $u Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

700    1_

$a Banaszewski, Marek $u Intensive Cardiac Therapy Clinic, Institute of Cardiology, Warsaw, Poland.

700    1_

$a Sionis, Alessandro $u Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.

700    1_

$a Spinar, Jindrich $u Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.

700    1_

$a Harjola, Veli-Pekka $u Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finland.

700    1_

$a Jurkko, Raija $u Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.

700    1_

$a Lassus, Johan $u Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.

710    2_

$a CardShock study investigators and for the GREAT Network

773    0_

$w MED00000236 $t The American journal of cardiology $x 1879-1913 $g Roč. 122, č. 2 (2018), s. 199-205

856    41

$u https://pubmed.ncbi.nlm.nih.gov/29778237 $y Pubmed

910    __

$a ABA008 $b sig $c sign $y a $z 0

990    __

$a 20191007 $b ABA008

991    __

$a 20191015115547 $b ABA008

999    __

$a ok $b bmc $g 1451894 $s 1073784

BAS    __

$a 3

BAS    __

$a PreBMC

BMC    __

$a 2018 $b 122 $c 2 $d 199-205 $e 20180420 $i 1879-1913 $m The American journal of cardiology $n Am J Cardiol $x MED00000236

LZP    __

$a Pubmed-20191007