Korean Circ J.  2018 Nov;48(11):1002-1011. 10.4070/kcj.2018.0048.

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

• Choi KH
• Han S
• Lee GY
• Choi JO
• Jeon ES
• Lee HY
• Lee SE
• Kim JJ
• Chae SC
• Baek SH
• Kang SM
• Choi DJ
• Yoo BS
• Kim KH
• Cho MC
• Park HY
• Oh BH

• KMID: 2422548
• DOI: http://doi.org/10.4070/kcj.2018.0048

Abstract

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 <−30 degree. The primary outcome was all-cause mortality.
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).

Keyword

Bundle-branch block; Heart failure; Electrocardiography

MeSH Terms

Bundle-Branch Block*
Dilatation
Electrocardiography
Extremities
Follow-Up Studies
Heart Failure*
Heart Ventricles
Heart*
Hospitals, University
Humans
Linear Models
Mortality
Multivariate Analysis
Stroke Volume

Figure

• 

  Figure 1 Study flow. AHFS = acute heart failure syndrome; ECG = electrocardiogram; IVCD = intra-ventricular conduction delay; KorAHF = Korean Acute Heart Failure; LAD = left axis deviation; LBBB = left bundle branch block; RBBB = right bundle branch block.

• 

  Figure 2 Kaplan-Meier curves of AHFS patients with LBBB according to the presence of LAD. Kaplan-Meier curve of all-cause death for AHFS patients with LBBB in the no LAD group (blue line) versus the LAD group (red line). AHFS = acute heart failure syndrome; LAD = left axis deviation; LBBB = left bundle branch block.

• 

  Figure 3 LOESS curves of the echocardiographic parameters according to the QRS axis. LOESS curves of the LVEF (A), E/A ratio (B), E/e′ (C), DT (D), LA size (E), and RVSP (F) according to the QRS axis. DT = deceleration time; LA = left atrium; LOESS = locally weighted scatterplot smoothing; LVEF = left ventricular ejection fraction; RVSP = right ventricular systolic pressure.

• 

  Figure 4 Kaplan-Meier curve of all-cause death in AHFS patients with LBBB according to RV dilatation criteria. Kaplan-Meier curve of all-cause death in AHFS patients with LBBB in the no RV dilatation group (blue line) versus RV dilatation group (red line). AHFS = acute heart failure syndrome; LBBB = left bundle branch block; RV = right ventricle.

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