Zhu-Ming Zhang1, Pentti M Rautaharju2, Ronald J Prineas2, Eric A Whitsel3, Larisa Tereshchenko4, Elsayed Z Soliman5. 1. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: zmzhang@wakehealth.edu. 2. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 4. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon. 5. Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; Department of Internal Medicine, Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Abstract
BACKGROUND: Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. METHODS AND RESULTS: Total 15,408 participants (mean age 54 years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-year follow-up, 4767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median value. In the pooled ICVD/LBBB group, the risk for CHD death was increased 15.9-fold in women and 6.04 fold in men, and for all-cause deaths 3.01-fold in women and 1.84-fold in men. However, the mortality risk in isolated RBBB group was only significantly increased in women but not in men. CONCLUSION: A wide spatial QRS/T angle in BBB is associated with increased risk for CHD and all-cause mortality over and above the predictive value for BBB alone. The risk for women is as high as or higher than that in men.
BACKGROUND: Repolarization abnormality in bundle branch blocks (BBB) is traditionally ignored. This study evaluated the prognostic value of QRS/T angle for mortality in the presence and absence of BBB. METHODS AND RESULTS: Total 15,408 participants (mean age 54 years, 55.2% women, 26.9% blacks, 2.8% with BBB) were from the Arteriosclerosis Risk in Communities Study. Sex stratified Cox regression models were used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for coronary heart disease (CHD) and all-cause mortality for wide spatial QRS/T angle with and without BBB including right BBB (RBBB), left BBB (LBBB) and indetermined-type ventricular conduction defect (IVCD) and RBBB combined with left anterior fascicular block. During a median 22-year follow-up, 4767 deaths occurred, 728 of them CHD deaths. Using the No-BBB with QRS/T angle below median value as gender-specific reference groups, the mortality risk increase was significant for both women and men with No-BBB and QRS/T angle above the median value. In the pooled ICVD/LBBB group, the risk for CHD death was increased 15.9-fold in women and 6.04 fold in men, and for all-cause deaths 3.01-fold in women and 1.84-fold in men. However, the mortality risk in isolated RBBB group was only significantly increased in women but not in men. CONCLUSION: A wide spatial QRS/T angle in BBB is associated with increased risk for CHD and all-cause mortality over and above the predictive value for BBB alone. The risk for women is as high as or higher than that in men.
Authors: Tian Gang Zhu; Chinmay Patel; Seth Martin; Xin Quan; Ying Wu; James F Burke; Michael Chernick; Peter R Kowey; Gan-Xin Yan Journal: Eur Heart J Date: 2009-01-15 Impact factor: 29.983
Authors: Wojciech Zareba; Helmut Klein; Iwona Cygankiewicz; W Jackson Hall; Scott McNitt; Mary Brown; David Cannom; James P Daubert; Michael Eldar; Michael R Gold; Jeffrey J Goldberger; Ilan Goldenberg; Edgar Lichstein; Heinz Pitschner; Mayer Rashtian; Scott Solomon; Sami Viskin; Paul Wang; Arthur J Moss Journal: Circulation Date: 2011-02-28 Impact factor: 29.690
Authors: Ilan Goldenberg; Arthur J Moss; W Jackson Hall; Elyse Foster; Jeffrey J Goldberger; Peter Santucci; Timothy Shinn; Scott Solomon; Jonathan S Steinberg; David Wilber; Alon Barsheshet; Scott McNitt; Wojciech Zareba; Helmut Klein Journal: Circulation Date: 2011-09-06 Impact factor: 29.690
Authors: Zhu-Ming Zhang; Ronald J Prineas; Douglas Case; Elsayed Z Soliman; Pentti M Rautaharju Journal: Am J Cardiol Date: 2007-06-18 Impact factor: 2.778
Authors: C Jan Willem Borleffs; Roderick W C Scherptong; Sum-Che Man; Guido H van Welsenes; Jeroen J Bax; Lieselot van Erven; Cees A Swenne; Martin J Schalij Journal: Circ Arrhythm Electrophysiol Date: 2009-08-05
Authors: Saara Sillanmäki; Jukka A Lipponen; Mika P Tarvainen; Tiina Laitinen; Marja Hedman; Antti Hedman; Antti Kivelä; Hanna Hämäläinen; Tomi Laitinen Journal: J Nucl Cardiol Date: 2018-02-08 Impact factor: 5.952
Authors: James D Pollard; Kazi T Haq; Katherine J Lutz; Nichole M Rogovoy; Kevin A Paternostro; Elsayed Z Soliman; Joseph Maher; Joao Ac Lima; Solomon Musani; Larisa G Tereshchenko Journal: BMJ Open Date: 2021-01-31 Impact factor: 2.692