Association between T-wave Discordance and the Development of Heart Failure in Left Bundle Branch Block Patients: Results from the Copenhagen ECG study

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Background: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. Methods: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. Results: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71–3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19–1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26–4.02) within 30 days and a HR of 1.67 (95%CI 1.25–2.23) after 30 days. Conclusion: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.

OriginalsprogEngelsk
TidsskriftJournal of Electrocardiology
Vol/bind52
Sider (fra-til)39-45
Antal sider7
ISSN0022-0736
DOI
StatusUdgivet - 1 jan. 2019

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Bundle-Branch Block
Electrocardiography
Heart Failure
Patient Care Bundles
Confidence Intervals
Primary Health Care
Patient Care
Direction compound

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    @article{c45258522e1c44e5899c45072d938a80,
    title = "Association between T-wave Discordance and the Development of Heart Failure in Left Bundle Branch Block Patients: Results from the Copenhagen ECG study",
    abstract = "Background: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. Methods: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. Results: In total, 244 of 913 patients (26.7{\%}) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7{\%}) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95{\%} Confidence interval [CI] 1.71–3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95{\%}CI 1.19–1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95{\%}CI 1.26–4.02) within 30 days and a HR of 1.67 (95{\%}CI 1.25–2.23) after 30 days. Conclusion: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.",
    keywords = "Concordance, Discordance, Heart failure, Left bundle branch block, QRS-T angle",
    author = "Jensen, {Johannes Riis} and Kragholm, {Kristian Hay} and B{\o}dker, {Karoline Willum} and Mortensen, {Rikke N{\o}rmark} and Claus Graff and Adrian Pietersen and Nielsen, {Jonas Bille} and Christoffer Polcwiartek and Bhupendar Tayal and Christian Torp-Pedersen and Peter S{\o}gaard and Hansen, {Steen M{\o}ller}",
    year = "2019",
    month = "1",
    day = "1",
    doi = "10.1016/j.jelectrocard.2018.11.001",
    language = "English",
    volume = "52",
    pages = "39--45",
    journal = "Journal of Electrocardiology",
    issn = "0022-0736",
    publisher = "Churchill Livingstone",

    }

    TY - JOUR

    T1 - Association between T-wave Discordance and the Development of Heart Failure in Left Bundle Branch Block Patients

    T2 - Results from the Copenhagen ECG study

    AU - Jensen, Johannes Riis

    AU - Kragholm, Kristian Hay

    AU - Bødker, Karoline Willum

    AU - Mortensen, Rikke Nørmark

    AU - Graff, Claus

    AU - Pietersen, Adrian

    AU - Nielsen, Jonas Bille

    AU - Polcwiartek, Christoffer

    AU - Tayal, Bhupendar

    AU - Torp-Pedersen, Christian

    AU - Søgaard, Peter

    AU - Hansen, Steen Møller

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. Methods: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. Results: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71–3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19–1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26–4.02) within 30 days and a HR of 1.67 (95%CI 1.25–2.23) after 30 days. Conclusion: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.

    AB - Background: In left bundle branch block (LBBB), discrepancies between depolarization and repolarization of the heart can be assessed by similar direction (concordant) or opposite direction (discordant) of the lateral T-waves compared to the direction of the QRS complex and by the QRS-T angle. We examined the association between discordant T-waves and high QRS-T angles for heart failure development in primary care LBBB patients. Methods: Between 2001 and 2011, we identified 2540 patients from primary care with LBBB without overt heart failure. We examined the development of heart failure in relation to two ECG measures: (1) LBBB as either discordant (two or three monophasic T-waves in the opposite direction of the QRS complex in leads I, V5 or V6) or concordant, and (2) the frontal plane QRS-T angle in quartile groups. Results: In total, 244 of 913 patients (26.7%) with discordant LBBB developed heart failure compared to 302 of 1627 patients (16.7%) with concordant LBBB. Multivariable Cox regression comparing discordant with concordant LBBB showed a hazard ratio (HR) of 2.58 (95% Confidence interval [CI] 1.71–3.89) for heart failure development within 30 days of follow-up and a HR of 1.45 (95%CI 1.19–1.77) after 30 days. For QRS-T angle, comparing the highest quartile (160°-180°) with the lowest quartile (0°-110°) we found a HR of 2.25 (95%CI 1.26–4.02) within 30 days and a HR of 1.67 (95%CI 1.25–2.23) after 30 days. Conclusion: T-wave discordance in lateral ECG leads and a high QRS-T angle are associated with heart failure development in primary care LBBB patients.

    KW - Concordance

    KW - Discordance

    KW - Heart failure

    KW - Left bundle branch block

    KW - QRS-T angle

    UR - http://www.scopus.com/inward/record.url?scp=85056192438&partnerID=8YFLogxK

    U2 - 10.1016/j.jelectrocard.2018.11.001

    DO - 10.1016/j.jelectrocard.2018.11.001

    M3 - Journal article

    VL - 52

    SP - 39

    EP - 45

    JO - Journal of Electrocardiology

    JF - Journal of Electrocardiology

    SN - 0022-0736

    ER -