This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.05.059v1 46/5/858    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Biagini, E. Articles by Poldermans, D. Search for Related Content PubMed PubMed Citation Articles by Biagini, E. Articles by Poldermans, D.

CLINICAL RESEARCH: HEART RHYTHM DISORDER

Prognostic Significance of Left Anterior Hemiblock in Patients With Suspected Coronary Artery Disease

Elena Biagini, MD^_*,, Abdou Elhendy, MD, FACC, Arend F.L. Schinkel, MD^_*, Stefan Nelwan, MD^_*, Vittoria Rizzello, MD^_*, Ron T. van Domburg, PhD^_*, Claudio Rapezzi, MD, Guido Rocchi, MD, Maarten L. Simoons, MD, FACC^_*, Jeroen J. Bax, MD and Don Poldermans, MD^_*,_*

^_* Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
Institute of Cardiology, S. Orsola Hospital, Bologna, Italy
University of Nebraska Medical Center, Omaha, Nebraska
Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands

Manuscript received February 15, 2005; revised manuscript received May 11, 2005, accepted May 15, 2005.

^_* Reprint requests and correspondence: Dr. Don Poldermans, Department of Cardiology, Thoraxcenter, Room Ba 300, Erasmus Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands. (Email: d.poldermans{at}erasmusmc.nl).

OBJECTIVES: This study was designed to assess the functional and prognostic significance of left anterior hemiblock (LAHB) in patients with no history of myocardial infarction referred for dobutamine stress echocardiography (DSE).

BACKGROUND: The significance of isolated LAHB in patients with suspected coronary artery disease (CAD) is unclear.

METHODS: We studied 1,187 patients with suspected CAD and no history of myocardial infarction who underwent DSE and were followed for occurrence of cardiac death.

RESULTS: Left anterior hemiblock was detected on baseline electrocardiogram in 159 patients (13%). Ischemia occurred more frequently in patients with LAHB (43% vs. 33%, p = 0.02). During a mean follow-up of 5.0 ± 2.5 years, 125 patients (11%) died of cardiac causes. The annual cardiac death rate was 4.9% in patients with LAHB and 1.9% for patients without (p < 0.0001). Patients with both LAHB and an abnormal DSE had the highest annual cardiac death rate (6.3%). In a Cox multivariable analysis, independent predictors of cardiac death were age, smoking, history of heart failure, diabetes, and ischemia. Left anterior hemiblock was independently associated with increased risk of cardiac death among patients with normal DSE (hazard ratio 1.8, 95% confidence interval 1.1 to 3.8) and in patients with abnormal DSE (hazard ratio 1.7, 95% confidence interval 1.1 to 2.7).

CONCLUSIONS: In patients with suspected CAD referred for stress testing, LAHB is associated with increased risk of cardiac death. This risk is persistent after adjustment for major clinical data and abnormalities on the stress echocardiogram. Therefore, isolated LAHB should not be considered a benign electrocardiographic abnormality in these patients.

Abbreviations and Acronyms   CAD = coronary artery disease   CI = confidence interval   DSE = dobutamine stress echocardiography   ECG = electrocardiogram   HR = hazard ratio   LAHB = left anterior hemiblock   LVH = left ventricular hypertrophy   MI = myocardial infarction

This article has been cited by other articles:

				R. Sicari, P. Nihoyannopoulos, A. Evangelista, J. Kasprzak, P. Lancellotti, D. Poldermans, J.-U. Voigt, J. L. Zamorano, and on behalf of the European Association of Echocardi Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC) Eur J Echocardiogr, July 1, 2008; 9(4): 415 - 437. [Abstract] [Full Text] [PDF]

				M. V. Elizari, R. S. Acunzo, and M. Ferreiro Hemiblocks Revisited Circulation, March 6, 2007; 115(9): 1154 - 1163. [Abstract] [Full Text] [PDF]

				S. Stern Electrocardiogram: Still the Cardiologist's Best Friend Circulation, May 16, 2006; 113(19): e753 - e756. [Full Text] [PDF]