Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography

Azhar A. Supariwala, Jose Ricardo F Po, Sameh Mohareb, Farhan Aslam, Firas Kaddaha, Zainab I. Mian, Farhan Chaudhry, Ahmed Otokiti, Farooq A. Chaudhry

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. Methods We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All-cause mortality data were obtained from the Social Security Death Index. Results There were 222 (3%) patients with right bundle branch block (RBBB) and 50 (0.7%) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95% CI: 1.4-4.2; P = 0.002). Conclusion A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.

Original languageEnglish (US)
Pages (from-to)483-489
Number of pages7
JournalEchocardiography
Volume32
Issue number3
DOIs
StatePublished - Mar 1 2015
Externally publishedYes

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Stress Echocardiography
Bundle-Branch Block
Stroke Volume
Mortality
Patient Rights
Exercise Test
Social Security
Coronary Artery Disease

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography. / Supariwala, Azhar A.; Po, Jose Ricardo F; Mohareb, Sameh; Aslam, Farhan; Kaddaha, Firas; Mian, Zainab I.; Chaudhry, Farhan; Otokiti, Ahmed; Chaudhry, Farooq A.

In: Echocardiography, Vol. 32, No. 3, 01.03.2015, p. 483-489.

Research output: Contribution to journalArticle

Supariwala, Azhar A. ; Po, Jose Ricardo F ; Mohareb, Sameh ; Aslam, Farhan ; Kaddaha, Firas ; Mian, Zainab I. ; Chaudhry, Farhan ; Otokiti, Ahmed ; Chaudhry, Farooq A. / Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography. In: Echocardiography. 2015 ; Vol. 32, No. 3. pp. 483-489.
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title = "Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography",
abstract = "Background The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. Methods We analyzed 7214 patients (58 ± 14 years; 57{\%} female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51{\%} of patients and exercise SE was performed in 49{\%}. All-cause mortality data were obtained from the Social Security Death Index. Results There were 222 (3{\%}) patients with right bundle branch block (RBBB) and 50 (0.7{\%}) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95{\%} CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5{\%}/year for patients with LBBB, 2.5{\%}/year for patients with RBBB, and 1.9{\%}/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95{\%} CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95{\%} CI: 1.4-4.2; P = 0.002). Conclusion A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.",
author = "Supariwala, {Azhar A.} and Po, {Jose Ricardo F} and Sameh Mohareb and Farhan Aslam and Firas Kaddaha and Mian, {Zainab I.} and Farhan Chaudhry and Ahmed Otokiti and Chaudhry, {Farooq A.}",
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T1 - Prevalence and long-term prognosis of patients with complete bundle branch block (right or left bundle branch) with normal left ventricular ejection fraction referred for stress echocardiography

AU - Supariwala, Azhar A.

AU - Po, Jose Ricardo F

AU - Mohareb, Sameh

AU - Aslam, Farhan

AU - Kaddaha, Firas

AU - Mian, Zainab I.

AU - Chaudhry, Farhan

AU - Otokiti, Ahmed

AU - Chaudhry, Farooq A.

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Background The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. Methods We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All-cause mortality data were obtained from the Social Security Death Index. Results There were 222 (3%) patients with right bundle branch block (RBBB) and 50 (0.7%) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95% CI: 1.4-4.2; P = 0.002). Conclusion A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.

AB - Background The prognostic value of stress echocardiography (SE) in patients with complete bundle branch blocks (BBB) with normal left ventricular ejection fraction (LVEF) has not been well described. We sought to determine the prognostic value of SE in patients with BBB and normal LVEF. Methods We analyzed 7214 patients (58 ± 14 years; 57% female) with a mean follow-up time of 9 ± 4 years. Dobutamine SE was performed in 51% of patients and exercise SE was performed in 49%. All-cause mortality data were obtained from the Social Security Death Index. Results There were 222 (3%) patients with right bundle branch block (RBBB) and 50 (0.7%) patients with left bundle branch block (LBBB). Patients with LBBB were 3 times more likely to have an abnormal stress test after adjusting for age, gender, mode of stress test, and coronary artery disease risk factors (OR = 3.3; 95% CI: 1.86-5.92; P < 0.001). The mortality rates were 4.5%/year for patients with LBBB, 2.5%/year for patients with RBBB, and 1.9%/year for patients without BBB (P < 0.001). Among patients with a normal SE, those with LBBB had similar mortality to those without LBBB (HR = 0.9; 95% CI: 0.4-2.2; P = 0.8). Patients with LBBB and abnormal SE had more than 2 times greater risk of all-cause mortality (HR = 2.4; 95% CI: 1.4-4.2; P = 0.002). Conclusion A normal stress echocardiogram in LBBB is associated with benign prognosis while those with LBBB and abnormal SE have the worst outcomes.

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U2 - 10.1111/echo.12680

DO - 10.1111/echo.12680

M3 - Article

VL - 32

SP - 483

EP - 489

JO - Echocardiography

JF - Echocardiography

SN - 0742-2822

IS - 3

ER -