Haldun MÜDERRİSOĞLU, Kerem Can YILMAZ, Suzan KESKİN, Bülent ÖZİN, Orçun ÇİFTCİ

Risk factors for coronary artery disease in left bundle branch block

Aim: The presence of left bundle branch block (LBBB) in the surface electrocardiogram makes the evalaution of patients for suspected angina pectoris difficult. A newly developed LBBB in patients with acute chest pain is an indication for primary percutaneous coronary intervention. However, it is difficult to evaluate the coronary artery disease (CAD) in stable patients with LBBB. In this study, we aimed to investigate the baseline demographic characteristics, electrocardiographic and echocardiographic findings in LBBB patients who had a preliminary diagnosis of CAD.Material and Methods: We enrolled a total of 216 consecutive patients with a LBBB who had undergone coronary angiography. Of these patients, severe coronary artery disease did not find in 123 (56%) patients, while 93 (44%) patients had severe coronary artery diseaseResults: The frequency of male sex, diabetes mellitus and hyperlipidemia were significantly higher in the CAD group (p=0.007, p=0.001, and p=0.012, respectively). Comparasion of electrocardiographic findings revealed no significant difference betweent the goups. In terms of the echocardiography findings, the left venticular ejection fraction was significantly lower and the left venticular end-diastolic volume was significantly higher in patients with CAD. We noted that patients with CAD had significiantly elevated creatinine levels compared to those who did not.Conclusion: The significant risk factors for CAD among patients with LBBB included diabetes mellitus, elevated creatinine levels, male sex, advanced age, and low left venticular ejection fraction. These risk factors should be incorporated with non-invasive tests in patients with who had a preliminary diagnosis of CAD, and a conventional angiography should be considered in these patients in an attempt to increase the specificity and sensitivity of the available diagnostic tests.

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1. Hardarson T, Arnason A, Elíasson GJ, et al. Left bundle branch block: prevalence, incidence, follow-up and outcome. Eur Heart J 1987;8:1075-9.
2. R Mulcahy, N Hickey, B Maurer. Aetiology of bundle-branch block. Br Heart J 1968;30:34-7. 3. Ibanez B, James SK. The 2017 ESC STEMI guidelines. Eur Heart J 2018;39;79-82.
4. P Francia, C Balla, F Paneni, et al. Left bundle-branch block-pathophysiology, prognosis, and clinical management. Clin Cardiol 2007;30:110-5.
5. Schneider JF, Thomas HE Jr, Kreger BE, et al. Newly acquired left bundle-branch block: the Framingham study. Ann Int Med 1979;90:303-10.
6. SW Rabkin, FA Mathewson, RB Tate. Natural history of left bundle-branch block. Br Heart J 1980;43:164-9.
7. Ono S, Nohara R, Kambara H, et al. Regional myocardial perfusion and glucose metabolism in experimental left bundle branch block. Circulation 1992;85:1125-31.
8. Koepfli P, Wyss CA, Gaemperli O, et al. Left bundle branch block causes relative but not absolute septal underperfusion during exercise. Eur Heart J 2009;30:2993-9.
9. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American college of cardiology foundation/American heart association task force on practice guidelines, and the American college of physicians, American association for thoracic surgery, preventive cardiovascular nurses association, society for cardiovascular angiography and interventions, and society of thoracic surgeons. Circulation 2012;126:e354-471.
10. Salerno M, Beller GA. Noninvasive assessment of myocardial perfusion. Circ. Cardiovasc Imaging 2009;2:412-24.
11. Inanir S, Caymaz O, Okay T, et al. Tc-99 m sestamibi gated SPECT in patients with left bundle branch block. Clin Nucl Med 2001;26:840-6.
12. Higgins JP, Williams G, Nagel JS, et al, Left bundle-branch block artifact on single photon emission computed tomography with technetium Tc 99m (Tc-99m) agents: mechanisms and a method to decrease false-positive interpretations. Am Heart J 2006;152:619-26.
13. TH Marwick. Stress echocardiography. Heart 2003;89:113-8.
14. Schartl M, S Beckmann, W Bocksch, et al, Stress echocardiography in special groups: in women, in left bundle branch block, in hypertension and after heart transplantation. Eur Heart J 1997;18:D63-7.
15. Ozeke O1, Aras D, Deveci B, et al. Comparison of presence and extent of coronary arrowing in patients with left bundle branch block without diabetes mellitus to patients with and without left bundle branch block but with diabetes mellitus. Am J Cardiol 2006;97:857-9.
16. S Ghaffari, N Rajabi, A Alizadeh, et al. Predictors of ventricular dysfunction and coronary artery disease in Iranian patients with left bundle branch block. Int J Cardiol 2008;130:291-3.
17. L Anghel, CA Georgescu. Particularities of coronary artery disease in hypertensive patients with left bundle branch block. Medica-a J Clin Med 2014;9:333-7.
18. Hashemi Jazi M, Nilforoush P, Gharipour M, et al. Main clinical determinants of the presence of coronary arter disease in patients with left bundle branch block. Acta Biomed 2015;86:267-72.
19. Jeevanantham V, Manne K, Sengodan M, et al Predictors of coronary artery disease in patients with left bundle branch block who undergo myocardial perfusion imaging. Cardiol J 2009;16:321-6.
20. Abrol R, Trost JC, Nguyen K, et al. Predictors of coronary artery disease in patients with left bundle branch block undergoing coronary angiography. Am J Cardiol 2006;98:1307-10.
21. Citro R, Galderisi M, Guarini P, et al. Left bundle branch block with and without coronary artery disease: which value for a tissue Doppler-derived post-systolic motion? Ital Heart J 2003;4:706-12.