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KMID : 0368120180480111002
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Korean Circulation Journal
2018 Volume.48 No. 11 p.1002 ~ p.1011
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Prognostic Significance of Left Axis Deviation in Acute Heart Failure Patients with Left Bundle branch block: an Analysis from the Korean Acute Heart Failure (KorAHF) Registry
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Choi Ki-Hong
Han Seong-Wook
Lee Ga-Yeon
Choi Jin-Oh
Jeon Eun-Seok
Lee Hae-Young
Lee Sang-Eun
Kim Jae-Joong
Chae Shung-Chull
Baek Sang-Hong
Kang Seok-Min
Choi Dong-Ju
Yoo Byung-Su
Kim Kye-Hun
Cho Myeong-Chan
Park Hyun-Young
Oh Byung-Hee
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Abstract
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Background and Objectives: The prognostic impact of left axis deviation (LAD) on clinical outcomes in acute heart failure syndrome (AHFS) with left bundle branch block (LBBB) is unknown. The aim of this study was to determine the prognostic significance of axis deviation in acute heart failure patients with LBBB.
Methods: Between March 2011 and February 2014, 292 consecutive AHFS patients with LBBB were recruited from 10 tertiary university hospitals. They were divided into groups with no LAD (n=189) or with LAD (n=103) groups according to QRS axis
Results: The median follow-up duration was 24 months. On multivariate analysis, the rate of all-cause death did not significantly differ between the normal axis and LAD groups (39.7% vs. 46.6%, adjusted hazard ratio, 1.01; 95% confidence interval, 0.66, 1.53; p=0.97). However, on the multiple linear regression analysis to evaluate the predictors of the left ventricular ejection fraction (LVEF), presence of LAD significantly predicted a worse LVEF (adjusted beta, ?3.25; 95% confidence interval, ?5.82, ?0.67; p=0.01). Right ventricle (RV) dilatation was defined as at least 2 of 3 electrocardiographic criteria (late R in lead aVR, low voltages in limb leads, and R/S ratio <1 in lead V5) and was more frequent in the LAD group than in the normal axis group (p<0.001).
Conclusions: Among the AHFS with LBBB patients, LAD did not predict mortality, but it could be used as a significant predictor of worse LVEF and RV dilatation (Trial registry at KorAHF registry, ClinicalTrial.gov, NCT01389843).
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KEYWORD
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Bundle-branch block, Heart failure, Electrocardiography
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