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Korean Circ J. 2018 Nov;48(11):1002-1011. doi: 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.

Author information

1
Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
2
Division of Cardiology, Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
3
Division of Cardiology, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea. esjeon1107@gmail.com.
4
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
5
Division of Cardiology, Department of Medicine, University of Ulsan College of Medicine, Seoul, Korea.
6
Division of Cardiology, Department of Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
7
Division of Cardiology, Department of Medicine, The Catholic University of Korea, Seoul, Korea.
8
Division of Cardiology, Department of Medicine, Yonsei University College of Medicine, Seoul, Korea.
9
Division of Cardiology, Department of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
10
Division of Cardiology, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
11
Division of Cardiology, Department of Medicine, Heart Research Center of Chonnam National University, Gwangju, Korea.
12
Division of Cardiology, Department of Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.
13
Division of Cardiovascular and Rare Diseases, Department of Biomedical Science, National Institute of Health (NIH), Osong, Korea.
#
Contributed equally

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).

KEYWORDS:

Bundle-branch block; Electrocardiography; Heart failure

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