Prediction of Left Ventricular Dysfunction on Basis of Ventricular Depolarization Time and Electrical Axis in Patients with Left Bundle Branch Block

Document Type : Original Article

Abstract

Background- Prolongation of ventricular depolarization time (QRS duration), particularly in left
bundle branch block (LBBB), is commonly associated with many cardiac diseases. We
propose that the QRS duration and degree of left-axis deviation (LAD) identify significant left
ventricular (LV) systolic dysfunction in patients with LBBB.
Methods- In this prospective study conducted in the cardiac ward, CCU and out-patient clinic of our
department in Babol from 2000 to 2003, 150 patients with a diagnosis of LBBB were divided
into two groups (QRS ≥160 and QRS<160 milliseconds). Then the relationship between QRS
duration, left axis deviation (LAD; axis between –30° and –90°) and echocardiographic LV
ejection fraction (EF) were derived by T-test, chi-square and linear regression analysis in stepwise
method.
Results- There was no significant difference in age and sex among the patients with or without
LAD and QRS duration less or greater than 160 milliseconds (p>0.05). The EF of patients
with LAD (n=64) and without LAD (n=86) was 48.64±14.63% and 52.10±13.98%,
respectively (p=0.143). The mean±SD EF (54.5±10.545%) of the patients with a QRS
duration of ≥160 milliseconds (n=19) was significantly more than the mean±SD EF
(23.89±5.466%) of the patients with a QRS duration of <160 milliseconds (n=131, p<0.001).
The QRS duration also had a significant (p<0.001) inverse correlation with EF (R = 0.926,
adjusted R2 = 0.857, SE of estimate = 5.42). However, the QRS axis was not significantly
correlated with EF and did not have added predictive value.
Conclusion- The QRS duration has a significant inverse relationship with EF and prolongation of
QRS duration (≥160 milliseconds) in the presence of LBBB is a marker of significant left
ventricular systolic dysfunction. The presence of LAD in LBBB does not signify a further
decrease in EF (Iranian Heart Journal 2008; 9 (2):29-36).

Keywords


Farzad Jalali MD, Seyyed Mohammad Miri MD, Pegah Karimi Elizei

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