Email this article Left bundle branch block in coronary artery disease: looking for new electrocardiographic markers
- Authors: Fedulaev Y.N.1, Makarova I.V.1, Grigorieva A.V.1, Kapitonova D.R.1, Khairetdinova G.A.1
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Affiliations:
- N. I. Pirogov Russian National Research Medical University
- Section: Original study articles
- Submitted: 28.10.2024
- Accepted: 19.03.2025
- Published: 23.03.2025
- URL: https://cardiosomatics.ru/2221-7185/article/view/639933
- DOI: https://doi.org/10.17816/CS639933
- ID: 639933
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Abstract
Complete left bundle branch block (LBBB) is an example of uninformative electrocardiogram (ECG) in context of myocardial ischemia. QRS-duration is an ECG-marker of ventricular dissynchrony in chronic heart failure (CHF) progression. QRS-fragmentation (fQRS) is a less common ECG parameter of local myocardial fibrosis, predictor of negative prognosis in coronary artery disease (CAD) and narrow QRS, associated with cardiovascular events, increased hospitalization and mortality. Few studies concern fQRS evaluation in wide QRS.
AIM: To perform a comparative study of clinical, instrumental and epidemiological characteristics in CAD patients with LBBB according to fQRS presence.
MATERIALS AND METHODS: 45 in-patients aged 76±8 years were included in the study. 10 patients had an evidence of fQRS (main group), 35 were without fQRS (control group). At the first stage (2018-2019) some clinical, electrocardiographic and echocardiographic (global and regional contractility of left ventricle) data were collected. Second stage (2024) included detailed analysis of the unified medical informational system documentation.
RESULTS: QTc interval (463 vs. 433 ms, p=0.028) and QRS-duration (160 vs. 120 ms, p=0.009) were significantly higher in the main group. A trend towards a lower left ventricular ejection fraction (EF) was seen in the main group (34.2±14.4% vs. 42.8±13.9% in the control, p=0,063). The groups differed in terms of CHF severity (p=0.043), grade 2B was observed in 80% of the main group participants and in 49% of the control. The median of fragmented ECG leads was 4.5. Hospitalization rate trends to be higher in the main group compared to the control (p=0.061). A total of 27 lethal outcomes were documented, most of cases were non-cardiac. 30% of the main group patients and 17.1% of the control died from progressive CHF. Causes of lethal outcomes did not significantly differ into groups.
CONCLUSION: FQRS registration is associated with still prolongation of QRS-complex and QTc interval in LBBB, trend to left ventricular EF reduction, increased hospitalization rate and CHF stage progression. It can be appreciated as a part of new prognostic model in CAD patients with deformed QRS-complexes.
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About the authors
Yuri N. Fedulaev
N. I. Pirogov Russian National Research Medical University
Email: kuwert@yandex.ru
ORCID iD: 0000-0003-4040-2971
SPIN-code: 2764-7250
Scopus Author ID: 6503940014
ResearcherId: K-7917-2018
Professor, MD, Dr. Sci. (Med.), Head of Department of Faculty Therapy IMC
Russian Federation, 117997, Russian Federation, Moscow, Ostrovityanova St., 1.Irina V. Makarova
N. I. Pirogov Russian National Research Medical University
Author for correspondence.
Email: irina-makarova93@mail.ru
ORCID iD: 0000-0001-5127-1300
SPIN-code: 3525-1775
Scopus Author ID: 57211044069
ResearcherId: ABE-1969-2020
MD, Cand. Sci. (Med.), Assistant Professor of Department of Faculty Therapy IMC
Russian Federation, 117997, Russian Federation, Moscow, Ostrovityanova St., 1.Alisa V. Grigorieva
N. I. Pirogov Russian National Research Medical University
Email: alic.19101999@mail.ru
ORCID iD: 0009-0009-5010-0687
MD, 2nd year resident of Department of Faculty Therapy IMC
Russian Federation, 117997, Russian Federation, Moscow, Ostrovityanova St., 1.Dzhamilya R. Kapitonova
N. I. Pirogov Russian National Research Medical University
Email: jam.kapiton@gmail.com
ORCID iD: 0009-0006-7519-0701
SPIN-code: 6806-0062
MD, 2nd year resident of Department of Faculty Therapy IMC
Russian Federation, 117997, Russian Federation, Moscow, Ostrovityanova St., 1.Gulfiya A. Khairetdinova
N. I. Pirogov Russian National Research Medical University
Email: sportcardio@mail.ru
ORCID iD: 0000-0003-4908-3591
SPIN-code: 5620-6080
Scopus Author ID: 37004797600
MD, Cand. Sci. (Med.), Assistant Professor of Department of Faculty Therapy IMC
Russian Federation, 117997, Russian Federation, Moscow, Ostrovityanova St., 1.References
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