AIMS: 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 with de novo AHF and acutely decompensated chronic heart failure (ADCHF). METHODS AND 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 had de novo AHF. LBBB, and IVCD were more common in ADCHF than in de novo AHF: 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 in de novo AHF (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 in de novo AHF and ADCHF. RBBB predicts mortality in de novo AHF, and IVCD in ADCHF. LBBB has no additive predictive value in AHF requiring hospitalization.

Cardiology Department Faculty Hospital Brno Czech Republic

Cardiology DepartmentFaculty Hospital BrnoCzech Republic; International Clinical Research Center Department of Cardiovascular DiseaseUniversity Hospital BrnoCzech Republic

Department of Cardiology and Cardiovascular Research Institute Basel University Hospital Basel Switzerland

Department of Medicine Helsinki University Hospital Finland

Division of Emergency Care Department of Medicine Helsinki University Hospital Finland

Heart and Lung Center Cardiology Helsinki University Hospital Finland

Zobrazit více v PubMed

Kashani A, Barold SS. Significance of QRS complex duration in patients with heart failure. J Am Coll Cardiol 2005; 46: 2183–92. PubMed

Wang NC, Maggioni AP, Konstam MA, Zannad F, Krasa HB, Burnett JC Jr, Grinfeld L, Swedberg K, Udelson JE, Cook T, Traver B, Zimmer C, Orlandi C, Gheorghiade M. Efficacy of vasopressin antagonism in heart failure outcome study with tolvaptan I. Clinical implications of QRS duration in patients hospitalized with worsening heart failure and reduced left ventricular ejection fraction. JAMA 2008; 299: 2656–66. PubMed

Mueller C, Laule‐Kilian K, Klima T, Breidthardt T, Hochholzer W, Perruchoud AP, Christ M. Right bundle branch block and long‐term mortality in patients with acute congestive heart failure. J Intern Med 2006; 260: 421–8. PubMed

Huvelle E, Fay R, Alla F, Cohen Solal A, Mebazaa A, Zannad F. Left bundle branch block and mortality in patients with acute heart failure syndrome: a substudy of the EFICA cohort. Eur J Heart Fail 2010; 12(2): 156–63. PubMed

Barsheshet A, Goldenberg I, Garty M, Gottlieb S, Sandach A, Laish‐Farkash A, Eldar M, Glikson M. Relation of bundle branch block to long‐term (four‐year) mortality in hospitalized patients with systolic heart failure. Am J Cardiol 2011; 107: 540–4. PubMed

Abdel‐Qadir HM, Tu JV, Austin PC, Wang JT, Lee DS. Bundle branch block patterns and long‐term outcomes in heart failure. Int J Cardiol 2011; 146: 213–8. PubMed

Lassus JP, Siirila‐Waris K, Nieminen MS, Tolonen J, Tarvasmaki T, Peuhkurinen K, Melin J, Pulkki K, Harjola VP, group F‐As . Long‐term survival after hospitalization for acute heart failure—differences in prognosis of acutely decompensated chronic and new‐onset acute heart failure. Int J Cardiol 2013; 168: 458–62. PubMed

Siirila‐Waris K, Lassus J, Melin J, Peuhkurinen K, Nieminen MS, Harjola VP, Group F‐AS. Characteristics, outcomes, and predictors of 1‐year mortality in patients hospitalized for acute heart failure. Eur Heart J 2006; 27 3011–7. PubMed

Breidthardt T, Irfan A, Klima T, Drexler B, Balmelli C, Arenja N, Socrates T, Ringger R, Heinisch C, Ziller R, Schifferli J, Meune C, Mueller C. Pathophysiology of lower extremity edema in acute heart failure revisited. Am J Med 2012; 125: 1124 e1–e8. PubMed

Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, Rautaharju PM, van Herpen G, Wagner GS, Wellens H, American Heart Association E , Arrhythmias Committee CoCC , American College of Cardiology F , Heart Rhythm S . AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society. Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol 2009; 53: 976–81. PubMed

Zimetbaum PJ, Buxton AE, Batsford W, Fisher JD, Hafley GE, Lee KL, O'Toole MF, Page RL, Reynolds M, Josephson ME. Electrocardiographic predictors of arrhythmic death and total mortality in the multicenter unsustained tachycardia trial. Circulation 2004; 110: 766–9. PubMed

Parenica J, Spinar J, Vitovec J, Widimsky P, Linhart A, Fedorco M, Vaclavik J, Miklik R, Felsoci M, Horakova K, Cihalik C, Malek F, Spinarova L, Belohlavek J, Kettner J, Zeman K, Dusek L, Jarkovsky J, investigators AM . Long‐term survival following acute heart failure: the Acute Heart Failure Database Main registry (AHEAD Main). Eur J Intern Med 2013; 24: 151–60. PubMed

Aro AL, Anttonen O, Tikkanen JT, Junttila MJ, Kerola T, Rissanen HA, Reunanen A, Huikuri HV. Intraventricular conduction delay in a standard 12‐lead electrocardiogram as a predictor of mortality in the general population. Circulation, Arrhythmia and Electrophysiology 2011; 4: 704–10. PubMed

Zhang ZM, Rautaharju PM, Prineas RJ, Loehr L, Rosamond W, Soliman EZ. Ventricular conduction defects and the risk of incident heart failure in the Atherosclerosis Risk in Communities (ARIC) Study. J Card Fail 2015; 21: 307–12. PubMed PMC

Hong SJ, Oh J, Kang SM, Youn JC, Han S, Jeon ES, Cho MC, Kim JJ, Yoo BS, Chae SC, Oh BH, Choi DJ, Lee MM, Ryu KH, Kor HFR. Clinical implication of right bundle branch block in hospitalized patients with acute heart failure: data from the Korean Heart Failure (KorHF) Registry. Int J Cardiol 2012; 157: 416–8. PubMed

Cinca J, Mendez A, Puig T, Ferrero A, Roig E, Vazquez R, Gonzalez‐Juanatey JR, Alonso‐Pulpon L, Delgado J, Brugada J, Pascual‐Figal D, investigators of the Spanish Heart Failure N . Differential clinical characteristics and prognosis of intraventricular conduction defects in patients with chronic heart failure. Eur J Heart Fail 2013; 15: 877–84. PubMed PMC

Pellicori P, Joseph AC, Zhang J, Lukaschuk E, Sherwi N, Bourantas CV, Loh H, Clark AL, Cleland JG. The relationship of QRS morphology with cardiac structure and function in patients with heart failure. Clinical research in cardiology: official journal of the German Cardiac Society 2015. PubMed

de Groote P, Millaire A, Foucher‐Hossein C, Nugue O, Marchandise X, Ducloux G, Lablanche JM. Right ventricular ejection fraction is an independent predictor of survival in patients with moderate heart failure. J Am Coll Cardiol 1998; 32: 948–54. PubMed

Ghio S, Gavazzi A, Campana C, Inserra C, Klersy C, Sebastiani R, Arbustini E, Recusani F, Tavazzi L. Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure. J Am Coll Cardiol 2001; 37: 183–8. PubMed

Aronson D, Darawsha W, Atamna A, Kaplan M, Makhoul BF, Mutlak D, Lessick J, Carasso S, Reisner S, Agmon Y, Dragu R, Azzam ZS. Pulmonary hypertension, right ventricular function, and clinical outcome in acute decompensated heart failure. J Card Fail 2013; 19: 665–71. PubMed

Lewinter C, Torp‐Pedersen C, Cleland JG, Kober L. Right and left bundle branch block as predictors of long‐term mortality following myocardial infarction. Eur J Heart Fail 2011; 13: 1349–54. PubMed

Steimle AE, Stevenson LW, Chelimsky‐Fallick C, Fonarow GC, Hamilton MA, Moriguchi JD, Kartashov A, Tillisch JH. Sustained hemodynamic efficacy of therapy tailored to reduce filling pressures in survivors with advanced heart failure. Circulation 1997; 96: 1165–72. PubMed

Nieminen MS, Bohm M, Cowie MR, Drexler H, Filippatos GS, Jondeau G, Hasin Y, Lopez‐Sendon J, Mebazaa A, Metra M, Rhodes A, Swedberg K, Priori SG, Garcia MA, Blanc JJ, Budaj A, Cowie MR, Dean V, Deckers J, Burgos EF, Lekakis J, Lindahl B, Mazzotta G, Morais J, Oto A, Smiseth OA, Garcia MA, Dickstein K, Albuquerque A, Conthe P, Crespo‐Leiro M, Ferrari R, Follath F, Gavazzi A, Janssens U, Komajda M, Morais J, Moreno R, Singer M, Singh S, Tendera M, Thygesen K, Guideline ESCCfP . Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: the Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 2005; 26: 384–416. PubMed

Haataja P, Nikus K, Kahonen M, Huhtala H, Nieminen T, Jula A, Reunanen A, Salomaa V, Sclarovsky S, Nieminen MS, Eskola M. Prevalence of ventricular conduction blocks in the resting electrocardiogram in a general population: the Health 2000 Survey. Int J Cardiol 2013; 167: 1953–60. PubMed

Sumner G, Salehian O, Yi Q, Healey J, Mathew J, Al‐Merri K, Al‐Nemer K, Mann JF, Dagenais G, Lonn E, Investigators H. The prognostic significance of bundle branch block in high‐risk chronic stable vascular disease patients: a report from the HOPE trial. J Cardiovasc Electrophysiol 2009; 20: 781–7. PubMed

Eriksson P, Hansson PO, Eriksson H, Dellborg M. Bundle‐branch block in a general male population: the study of men born 1913. Circulation 1998; 98: 2494–500. PubMed

Brignole M, Auricchio A, Baron‐Esquivias G, Bordachar P, Boriani G, Breithardt OA, Cleland J, Deharo JC, Delgado V, Elliott PM, Gorenek B, Israel CW, Leclercq C, Linde C, Mont L, Padeletti L, Sutton R, Vardas PE, Guidelines ESCCfP , Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, Document R, Kirchhof P, Blomstrom‐Lundqvist C, Badano LP, Aliyev F, Bansch D, Baumgartner H, Bsata W, Buser P, Charron P, Daubert JC, Dobreanu D, Faerestrand S, Hasdai D, Hoes AW, Le Heuzey JY, Mavrakis H, McDonagh T, Merino JL, Nawar MM, Nielsen JC, Pieske B, Poposka L, Ruschitzka F, Tendera M, Van Gelder IC, Wilson CM. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013; 34: 2281–329. PubMed

Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, American College of Cardiology F , American Heart Association Task Force on Practice G , Heart Rhythm S . 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device‐based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2013; 127: e283–352. PubMed

Tabrizi F, Englund A, Rosenqvist M, Wallentin L, Stenestrand U. Influence of left bundle branch block on long‐term mortality in a population with heart failure. Eur Heart J 2007; 28: 2449–55. PubMed

Stenestrand U, Tabrizi F, Lindback J, Englund A, Rosenqvist M, Wallentin L. Comorbidity and myocardial dysfunction are the main explanations for the higher 1‐year mortality in acute myocardial infarction with left bundle‐branch block. Circulation 2004; 110: 1896–902. PubMed

Lassus J, Harjola VP, Sund R, Siirila‐Waris K, Melin J, Peuhkurinen K, Pulkki K, Nieminen MS, group F‐AS . Prognostic value of cystatin C in acute heart failure in relation to other markers of renal function and NT‐proBNP. Eur Heart J 2007; 28: 1841–7. PubMed

Maisel AS, Peacock WF, McMullin N, Jessie R, Fonarow GC, Wynne J, Mills RM. Timing of immunoreactive B‐type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis. J Am Coll Cardiol 2008; 52: 534–40. PubMed

Mebazaa A, Yilmaz MB, Levy P, Ponikowski P, Peacock WF, Laribi S, Ristic AD, Lambrinou E, Masip J, Riley JP, McDonagh T, Mueller C, deFilippi C, Harjola VP, Thiele H, Piepoli MF, Metra M, Maggioni A, McMurray J, Dickstein K, Damman K, Seferovic PM, Ruschitzka F, Leite‐Moreira AF, Bellou A, Anker SD, Filippatos G. Recommendations on pre‐hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. Eur J Heart Fail 2015; 17: 544–58. PubMed

Iuliano S, Fisher SG, Karasik PE, Fletcher RD, Singh SN. Department of Veterans Affairs Survival Trial of Antiarrhythmic Therapy in Congestive Heart F. QRS duration and mortality in patients with congestive heart failure. Am Heart J 2002; 143: 1085–91. PubMed

Shamim W, Francis DP, Yousufuddin M, Varney S, Pieopli MF, Anker SD, Coats AJ. Intraventricular conduction delay: a prognostic marker in chronic heart failure. Int J Cardiol 1999; 70: 171–8. PubMed