Abstract
Purpose
To investigate the prognostic implications of conduction defects in subjects without
proven coronary artery disease who had been referred for stress echocardiography.
Methods
The study sample consisted of 1230 patients (574 men and 656 women; mean [± SD] age,
63 ± 10 years) who underwent stress echocardiography with dipyridamole (n = 780) or
dobutamine (n = 450) to evaluate suspected coronary artery disease. A summary wall
motion score (on a 1 to 4 scale) was calculated. Patients were followed for a mean
of 41 ± 27 months; mortality was the only endpoint.
Results
Four hundred and twenty patients (34%) had intraventricular conduction defects on
a resting electrocardiogram (173 with complete left bundle branch block, 98 with isolated
right bundle branch block, 43 with right bundle branch block with left anterior hemiblock,
and 106 with left anterior hemiblock). Ischemia at stress echo (new or worsening of
preexisting wall motion abnormality) was found in 250 patients (20%). There were 56
deaths during follow-up; 138 patients underwent revascularization and were censored.
Multivariate predictors of mortality were resting wall motion score index (hazard
ratio [HR] = 6.0 per unit increase; 95% confidence interval [CI]: 2.3 to 16; P <0.0001), ischemia at stress echo (HR = 3.9; 95% CI: 2.2 to 6.7; P <0.0001), age >65 years (HR = 3.2; 95% CI: 1.7 to 5.9; P <0.0001), hypertension (HR = 1.8; 95% CI: 1.1 to 3.2; P = 0.03), and right bundle branch block with left anterior hemiblock (HR = 3.7; 95%
CI: 1.8 to 7.5; P <0.0001). The other three forms of intraventricular conduction defects (left bundle
branch block, isolated complete right bundle branch block, and left anterior hemiblock)
were not associated with mortality in multivariate analyses, or among the 980 patients
who did not have ischemia.
Conclusion
Right bundle branch block with left anterior hemiblock is an independent predictor
of mortality in patients with suspected coronary artery disease undergoing stress
echocardiography, whereas isolated right bundle branch block is associated with outcomes
similar to those observed in patients with no conduction defects.
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Article info
Publication history
Accepted:
March 18,
2003
Received:
June 25,
2002
Identification
Copyright
© 2003 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
