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

Ki Hong Choi, Seongwook Han, Ga Yeon Lee, Jin Oh Choi, Eun Seok Jeon, Hae Young Lee, Sang Eun Lee, Jae Joong Kim, Shung Chull Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Kye Hun Kim, Myeong Chan Cho, Hyun Young Park, Byung Hee Oh

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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).

Original languageEnglish
Pages (from-to)1002-1011
Number of pages10
JournalKorean Circulation Journal
Volume48
Issue number11
DOIs
Publication statusPublished - 2018 Nov

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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    Choi, K. H., Han, S., Lee, G. Y., Choi, J. O., Jeon, E. S., Lee, H. Y., Lee, S. E., Kim, J. J., Chae, S. C., Baek, S. H., Kang, S. M., Choi, D. J., Yoo, B. S., Kim, K. H., Cho, M. C., Park, H. Y., & Oh, B. H. (2018). 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. Korean Circulation Journal, 48(11), 1002-1011. https://doi.org/10.4070/kcj.2018.0048