TY - JOUR
T1 - Mortality in patients with right bundle-branch block in the absence of cardiovascular disease
AU - Gaba, Prakriti
AU - Pedrotty, Dawn
AU - Desimone, Christopher V.
AU - Bonikowske, Amanda R.
AU - Allison, Thomas G.
AU - Kapa, Suraj
N1 - Publisher Copyright:
© 2020 The Authors.
PY - 2020
Y1 - 2020
N2 - BACKGROUND: Right bundle-branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding. However, some studies have suggested increased risk of cardiovascular morbidity and mortality. We sought to evaluate risk attributable to incidental RBBB in patients without prior diagnosis of cardiovascular disease (CVD). METHODS AND RESULTS: We reviewed the Mayo Clinic Integrated Stress Center database for exercise stress tests performed from 1993 to 2010. Patients with no known CVD—defined as absence of coronary disease, structural heart disease, heart failure, or cerebrovascular disease—were selected. Only Minnesota residents were included, all of whom had full mortality and outcomes data. There were 22 806 patients without CVD identified; 220 of whom (0.96%) had RBBB, followed for 6 to 23 years (mean 12.4±5.1). There were 8256 women (36.2%), mean age was 52±11 years; and 1837 deaths (8.05%), includ-ing 645 cardiovascular-related deaths (2.83%), occurred over follow-up. RBBB was predictive of all-cause (hazard ratio [HR], 1.5; 95% CI, 1.1–2.0; P=0.0058) and cardiovascular-related mortality (HR,1.7; 95% CI, 1.1–2.8; P=0.0178) after adjusting for age, sex, diabetes mellitus, hypertension, obesity, current and past history of smoking, and use of a heart rate-lowering drug. Patients with RBBB exhibited more hypertension (34.1% versus 23.7%, P<0.0003), decreased functional aerobic capacity (82±25% versus 90±24%; P<0.0001), slower heart rate recovery (13.5±11.5 versus 17.1±9.4 bpm; P<0.0001), and more dysp-nea (28.2% versus 22.4%; P<0.0399) on exercise testing. CONCLUSIONS: Patients with RBBB without CVD have increased risk of all-cause mortality, cardiovascular-related mortality, and lower exercise tolerance. These data suggest RBBB may be a marker of early CVD and merit further prospective evaluation.
AB - BACKGROUND: Right bundle-branch block (RBBB) occurs in 0.2% to 1.3% of people and is considered a benign finding. However, some studies have suggested increased risk of cardiovascular morbidity and mortality. We sought to evaluate risk attributable to incidental RBBB in patients without prior diagnosis of cardiovascular disease (CVD). METHODS AND RESULTS: We reviewed the Mayo Clinic Integrated Stress Center database for exercise stress tests performed from 1993 to 2010. Patients with no known CVD—defined as absence of coronary disease, structural heart disease, heart failure, or cerebrovascular disease—were selected. Only Minnesota residents were included, all of whom had full mortality and outcomes data. There were 22 806 patients without CVD identified; 220 of whom (0.96%) had RBBB, followed for 6 to 23 years (mean 12.4±5.1). There were 8256 women (36.2%), mean age was 52±11 years; and 1837 deaths (8.05%), includ-ing 645 cardiovascular-related deaths (2.83%), occurred over follow-up. RBBB was predictive of all-cause (hazard ratio [HR], 1.5; 95% CI, 1.1–2.0; P=0.0058) and cardiovascular-related mortality (HR,1.7; 95% CI, 1.1–2.8; P=0.0178) after adjusting for age, sex, diabetes mellitus, hypertension, obesity, current and past history of smoking, and use of a heart rate-lowering drug. Patients with RBBB exhibited more hypertension (34.1% versus 23.7%, P<0.0003), decreased functional aerobic capacity (82±25% versus 90±24%; P<0.0001), slower heart rate recovery (13.5±11.5 versus 17.1±9.4 bpm; P<0.0001), and more dysp-nea (28.2% versus 22.4%; P<0.0399) on exercise testing. CONCLUSIONS: Patients with RBBB without CVD have increased risk of all-cause mortality, cardiovascular-related mortality, and lower exercise tolerance. These data suggest RBBB may be a marker of early CVD and merit further prospective evaluation.
KW - ECG
KW - Mortality
KW - Right bundle-branch block
KW - Stress testing
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U2 - 10.1161/JAHA.120.017430
DO - 10.1161/JAHA.120.017430
M3 - Article
C2 - 32924743
AN - SCOPUS:85092681108
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e017430
ER -