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Effect of Left Ventricular Conduction Delay on All-Cause and Cardiovascular Mortality (from the PRECISION Trial)

Kiehl, Erich L. ; Menon, Venu ; Mandsager, Kyle T. ; Wolski, Katherine E. ; Wisniewski, Lisa ; Nissen, Steven E. ; Lincoff, A. Michael ; Borer, Jeffrey S. ; Lüscher, Thomas F. ; Cantillon, Daniel J.

The American journal of cardiology, 2019-10, Vol.124 (7), p.1049-1055 [Periódico revisado por pares]

United States: Elsevier Inc

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Título:
Effect of Left Ventricular Conduction Delay on All-Cause and Cardiovascular Mortality (from the PRECISION Trial)
Autor: Kiehl, Erich L. ; Menon, Venu ; Mandsager, Kyle T. ; Wolski, Katherine E. ; Wisniewski, Lisa ; Nissen, Steven E. ; Lincoff, A. Michael ; Borer, Jeffrey S. ; Lüscher, Thomas F. ; Cantillon, Daniel J.
Assuntos: Aged ; Cardiac Conduction System Disease - complications ; Cardiac Conduction System Disease - diagnosis ; Cardiac Conduction System Disease - mortality ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - complications ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - mortality ; Classification ; Cohort Studies ; Coronary artery ; Coronary artery disease ; Delay ; Diabetes ; Diabetes mellitus ; Disease control ; Echocardiography ; EKG ; Electrocardiography ; Female ; Health risk assessment ; Health risks ; Heart ; Heart diseases ; Hospitalization ; Humans ; Hypertrophy ; Male ; Medical prognosis ; Middle Aged ; Morphology ; Mortality ; Patients ; Prognosis ; Prolongation ; Randomization ; Ratios ; Rheumatoid arthritis ; Risk Factors ; Survival Rate ; Ventricle ; Ventricular Dysfunction, Left - complications ; Ventricular Dysfunction, Left - diagnosis ; Ventricular Dysfunction, Left - mortality
É parte de: The American journal of cardiology, 2019-10, Vol.124 (7), p.1049-1055
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-News-1
ObjectType-Feature-3
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Descrição: The prognosis associated with prolonged intraventricular conduction on electrocardiogram (ECG) remains uncertain. We aimed to compare clinical outcomes of narrow versus prolonged intraventricular conduction on ECG stratified by QRS morphology and cardiovascular disease (CVD) status. A post-hoc analysis was performed of the randomized-control PRECISION trial. Patients with centrally adjudicated, nonpaced baseline ECGs were included. QRS duration was classified narrow (≤100 ms) versus prolonged (>100 ms) with additional categorization into left (LBBB) or right (RBBB) bundle branch block or nonspecific intraventricular conduction delay (IVCD). IVCD was subclassified if left ventricular conduction delay (LVCD) was present (L-IVCD) or absent (O-IVCD). The primary outcome was adjudicated all-cause and cardiovascular (CV) mortality. Of 24,081 patients randomized, 22,067 (92%) were included with follow-up 34 ± 13 months. Study patients were 63 ± 9 years, 64% female, 75% Caucasian, 23% with established CVD. The prevalence of QRS prolongation was 5.6% (1,240): 760 right bundle branch block (3.4%), 313 LBBB (1.4%), and 161 IVCD (0.7%), 95 subclassified L-IVCD (0.4%). After adjustment, LBBB and L-IVCD were similarly associated with increased all-cause (LBBB: 2.3 [1.4 to 3.8], p = 0.001; L-IVCD: 4.0 [2.1 to 7.9], p <0.001) and CV (LBBB: 3.6 [2.0 to 6.5], p <0.001; L-IVCD 3.6 [1.3 to 9.7], p = 0.001) mortality. The presence of LVCD (LBBB or L-IVCD) was associated with all-cause (2.8 [1.8 to 4.2], p <0.001) and CV (3.6 [2.2 to 6.1], p <0.001) mortality exceeding the observed risks of coronary artery disease, left ventricular hypertrophy, or diabetes. The LVCD hazard persisted across QRS durations (100 to 120 vs >120 ms) and CVD status. In conclusion, LVCD, whether LBBB or L-IVCD, was strongly associated with increased mortality in patients with and at-risk for CVD.
Editor: United States: Elsevier Inc
Idioma: Inglês

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Effect of Left Ventricular Conduction Delay on All-Cause and Cardiovascular Mortality (from the PRECISION Trial)

Kiehl, Erich L. ; Menon, Venu ; Mandsager, Kyle T. ; Wolski, Katherine E. ; Wisniewski, Lisa ; Nissen, Steven E. ; Lincoff, A. Michael ; Borer, Jeffrey S. ; Lüscher, Thomas F. ; Cantillon, Daniel J.

United States: Elsevier Inc

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