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Mortality Risk Associated With Bundle Branch Blocks and Related Repolarization Abnormalities (from the Women's Health Initiative [WHI]) - 26/10/12

Doi : 10.1016/j.amjcard.2012.06.060 
Zhu-ming Zhang, MD, MPH a, , Pentti M. Rautaharju, MD, PhD a, Elsayed Z. Soliman, MD, MSc, MS a, JoAnn E. Manson, MD, PhD b, Michael E. Cain, MD c, Lisa W. Martin, MD d, Anthony A. Bavry, MD, MPH e, Laxmi Mehta, MD f, Mara Vitolins, PhD a, Ronald J. Prineas, MD, PhD a
a Epidemiological Cardiology Research Center, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina 
b Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 
c University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York 
d Division of Cardiology, George Washington University, Washington, District of Columbia 
e Department of Medicine, University of Florida, Gainesville, Florida 
f The Ohio State University Medical Center, Columbus, Ohio 

Corresponding author: Tel: 336-716-0835; fax: 336-716-0834

Riassunto

Electrocardiographic bundle branch block (BBB) has higher cardiac and all-cause death. However, reports on the association between BBBs and mortality in the general populations are conflicting. The aim of this study was to evaluate the risk for coronary heart disease (CHD) and all-cause death associated with left BBB (LBBB) and right BBB (RBBB) during 14 years of follow-up in 66,450 participants from the Women's Health Initiative (WHI) study. Cox proportional-hazards regression was performed for mortality risk in Women with LBBB (n = 714) and those with RBBB (n = 832). In risk models adjusted for demographic and clinical risk factors in women with cardiovascular disease (CVD), hazard ratios for CHD death were 2.92 (95% confidence interval 2.08 to 4.08, p <0.001) for LBBB and 1.62 (95% confidence interval 1.08 to 2.43, p <0.05) for RBBB, and only LBBB was a significant predictor of all-cause death (hazard ratio 1.43, 95% confidence interval 1.11 to 1.83, p <0.01). In CVD-free women, only LBBB was a significant predictor of CHD death (fully adjusted hazard ratio 2.17, 95% confidence interval 1.37 to 3.43, p <0.01), and neither blocks was predictive of all-cause death. From several repolarization variables that were significant mortality predictors in univariate risk models, after adjustment for other electrocardiographic covariates and risk factors, ST J-point depression in lead aVL ≤−30 μV in women with LBBB was an independent predictor of CHD death, with a more than fivefold increase in risk. None of the repolarization variables were independent predictors in women with RBBB. In conclusion, prevalent LBBB in CVD-free women and LBBB and RBBB in women with CVD were significant predictors of CHD death. In women with LBBB, ST J-point depression in lead aVL was a strong independent predictor of CHD death.

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 The Women's Health Initiative program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.


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Vol 110 - N° 10

P. 1489-1495 - novembre 2012 Ritorno al numero
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