Blood Pressure (Mar 2019)

Association of left bundle branch block with new onset abnormal wall motion in treated hypertensive patients with left ventricle hypertrophy: the LIFE Echo Sub-study

  • Ildri M. Stokke,
  • Zhi Bin Li,
  • Silvana Cicala,
  • Peter M. Okin,
  • Sverre E. Kjeldsen,
  • Richard B. Devereux,
  • Kristian Wachtell

DOI
https://doi.org/10.1080/08037051.2019.1569463
Journal volume & issue
Vol. 28, no. 2
pp. 84 – 92

Abstract

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Aims: We aimed to investigate whether left bundle branch block (LBBB) is related to new-onset left ventricle (LV) wall motion abnormalities during treatment in hypertensive patients with electrocardiographic (ECG) defined left ventricular hypertrophy (LVH). Methods and results: 960 patients with essential hypertension and ECG-LVH participating in the LIFE Echo Sub-study were investigated at baseline and annually with echocardiography, during randomized antihypertensive therapy. After excluding patients with LV wall motion abnormalities at baseline and patients developing new-onset LBBB during study time, we investigated 784 patients. The participants with (n = 32) and without (n = 752) LBBB were similar regarding most baseline variables. Logistic regression models controlling for LV mass index, Framingham risk score, and randomized treatment assignment were used to assess the odds ratio of developing new-onset abnormal LV wall motion on annual follow-up echocardiograms. The likelihood of developing new global LV wall motion abnormalities in patients with LBBB was not higher compared to those without LBBB except at year 5 (p = .002). The likelihood of developing new segmental LV wall motion abnormalities in patients with LBBB was however higher compared to patients without LBBB after 1 year (OR = 3.1, 95% CI = 0.7–14.2, p = .173); 2 years (OR = 6.9, 2.1–22.4, p = .003); 3 years (OR = 5.3, 2.0–14.3, p < .001), 4 years (OR = 4.0, 1.6–10.3, p = .003 and 5 years (OR = 4.1, 1.0–16.2, p = .394) of treatment. Conclusion: Among patients with ECG-LVH, undergoing antihypertensive treatment, the presence of LBBB independently identifies individuals with ∼3- to 7-fold greater odds of developing new segmental abnormal LV wall motion. These findings suggest that LBBB may be a marker for progressive myocardial disease.

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