Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience

Kent Stephenson, Hicham Skali, John J V McMurray, Eric J. Velazquez, Philip G. Aylward, Lars Kober, Frans Van de Werf, Harvey D. White, Karen S. Pieper, Robert M. Califf, Scott D. Solomon, Marc A. Pfeffer

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. Results: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6). Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.

LanguageEnglish
Pages308-313
Number of pages6
JournalHeart Rhythm
Volume4
Issue number3
DOIs
Publication statusPublished - 1 Mar 2007

Keywords

  • Heart failure
  • Left bundle branch block
  • Left ventricular systolic dysfunction
  • Mortality
  • Myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Stephenson, K., Skali, H., McMurray, J. J. V., Velazquez, E. J., Aylward, P. G., Kober, L., ... Pfeffer, M. A. (2007). Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience. Heart Rhythm, 4(3), 308-313. https://doi.org/10.1016/j.hrthm.2006.11.021
Stephenson, Kent ; Skali, Hicham ; McMurray, John J V ; Velazquez, Eric J. ; Aylward, Philip G. ; Kober, Lars ; Van de Werf, Frans ; White, Harvey D. ; Pieper, Karen S. ; Califf, Robert M. ; Solomon, Scott D. ; Pfeffer, Marc A. / Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction : The VALIANT experience. In: Heart Rhythm. 2007 ; Vol. 4, No. 3. pp. 308-313.
@article{8e64648c47b646f0a6fb629a85673c27,
title = "Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience",
abstract = "Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. Results: At follow-up, patients with new LBBB (608 [4.2{\%}]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95{\%} confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95{\%} CI 1.2-1.7), HF (HR 1.3, 95{\%} CI 1.1-1.6), MI (HR 1.5, 95{\%} CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95{\%} CI 1.2-1.6). Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.",
keywords = "Heart failure, Left bundle branch block, Left ventricular systolic dysfunction, Mortality, Myocardial infarction",
author = "Kent Stephenson and Hicham Skali and McMurray, {John J V} and Velazquez, {Eric J.} and Aylward, {Philip G.} and Lars Kober and {Van de Werf}, Frans and White, {Harvey D.} and Pieper, {Karen S.} and Califf, {Robert M.} and Solomon, {Scott D.} and Pfeffer, {Marc A.}",
year = "2007",
month = "3",
day = "1",
doi = "10.1016/j.hrthm.2006.11.021",
language = "English",
volume = "4",
pages = "308--313",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "3",

}

Stephenson, K, Skali, H, McMurray, JJV, Velazquez, EJ, Aylward, PG, Kober, L, Van de Werf, F, White, HD, Pieper, KS, Califf, RM, Solomon, SD & Pfeffer, MA 2007, 'Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience', Heart Rhythm, vol. 4, no. 3, pp. 308-313. https://doi.org/10.1016/j.hrthm.2006.11.021

Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction : The VALIANT experience. / Stephenson, Kent; Skali, Hicham; McMurray, John J V; Velazquez, Eric J.; Aylward, Philip G.; Kober, Lars; Van de Werf, Frans; White, Harvey D.; Pieper, Karen S.; Califf, Robert M.; Solomon, Scott D.; Pfeffer, Marc A.

In: Heart Rhythm, Vol. 4, No. 3, 01.03.2007, p. 308-313.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction

T2 - Heart Rhythm

AU - Stephenson, Kent

AU - Skali, Hicham

AU - McMurray, John J V

AU - Velazquez, Eric J.

AU - Aylward, Philip G.

AU - Kober, Lars

AU - Van de Werf, Frans

AU - White, Harvey D.

AU - Pieper, Karen S.

AU - Califf, Robert M.

AU - Solomon, Scott D.

AU - Pfeffer, Marc A.

PY - 2007/3/1

Y1 - 2007/3/1

N2 - Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. Results: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6). Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.

AB - Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. Results: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6). Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.

KW - Heart failure

KW - Left bundle branch block

KW - Left ventricular systolic dysfunction

KW - Mortality

KW - Myocardial infarction

UR - http://www.scopus.com/inward/record.url?scp=33847314814&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2006.11.021

DO - 10.1016/j.hrthm.2006.11.021

M3 - Article

VL - 4

SP - 308

EP - 313

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 3

ER -