Influence of Right and Left Bundle Branch Block in Patients With Cardiogenic Shock and Cardiac Arrest.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Medicine Pub Date : 2024-10-29 DOI:10.1097/CCM.0000000000006459

Jonas Rusnak, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Jan Forner, Alexander Schmitt, Muharrem Akin, Péter Tajti, Kambis Mashayekhi, Mohamed Ayoub, Ibrahim Akin, Michael Behnes

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引用次数: 0

Abstract

Objectives: The study investigates the prognostic impact of right bundle branch block (RBBB) and left bundle branch block (LBBB) in patients with cardiogenic shock (CS) compared with no bundle branch block (BBB). In patients with heart failure, existence of RBBB and LBBB has influence on prognosis.

Design: Prospective registry-study.

Setting: ICU of a tertiary academic hospital in Germany.

Patients: Adult patients with CS.

Interventions: None.

Measurements and main results: Consecutive patients with CS were included. The prognostic impact of RBBB and LBBB on 30-day all-cause mortality was tested within the entire cohort and in the subgroup of CS patients with cardiac arrest at admission. The final study cohort comprised 248 patients. Patients with RBBB showed the highest 30-day all-cause mortality followed by LBBB and no BBB (72.5% vs. 52.9% vs. 50.0%; log-rank p = 0.015). These findings were consistent even after solely including CS patients with cardiac arrest (90.0% vs. 73.3% vs. 62.2%; log-rank p = 0.008). After adjustment for lactate, norepinephrine, troponin I, Acute Physiology Score, Society of Cardiovascular Angiography & Interventions shock stage, and heart rate in a multivariable Cox regression analysis, RBBB still revealed a negative impact on 30-day all-cause mortality (hazard ratio [HR], 1.807; 95% CI, 1.107-2.947; p = 0.018), whereas LBBB was not associated with 30-day all-cause mortality. In this multivariable Cox regression model lactate (HR, 1.065; 95% CI, 1.018-1.115; p = 0.006), troponin I (HR, 1.003; 95% CI, 1.001-1.005; p = 0.001), and Acute Physiology Score (HR, 1.033; 95% CI, 1.001-1.066; p = 0.041) were as well associated with 30-day all-cause mortality. Finally, no association of RBBB was found with the incidence of liver or severe renal failure.

Conclusions: Besides the Acute Physiology Score, lactate, and troponin levels, RBBB was associated with an increased 30-day all-cause mortality in consecutive CS patients with and without cardiac arrest, whereas LBBB showed no prognostic impact.

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右束支传导阻滞和左束支传导阻滞对心源性休克和心脏骤停患者的影响。

研究目的该研究探讨了右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）与无束支传导阻滞（BBB）相比对心源性休克（CS）患者预后的影响。在心力衰竭患者中，RBBB和LBBB的存在对预后有影响：前瞻性登记研究：患者： CS成人患者：干预措施：无：测量和主要结果研究纳入了连续的 CS 患者。在整个队列和入院时心脏骤停的 CS 患者亚组中测试了 RBBB 和 LBBB 对 30 天全因死亡率的预后影响。最终的研究队列由 248 名患者组成。RBBB 患者的 30 天全因死亡率最高，其次是 LBBB 和无 BBB（72.5% vs. 52.9% vs. 50.0%；log-rank p = 0.015）。即使仅将心脏骤停的 CS 患者包括在内，这些结果也是一致的（90.0% vs. 73.3% vs. 62.2%；log-rank p = 0.008）。在多变量 Cox 回归分析中对乳酸、去甲肾上腺素、肌钙蛋白 I、急性生理学评分、心血管血管造影与介入学会休克分期和心率进行调整后，RBBB 仍对 30 天全因死亡率有负面影响（危险比 [HR]，1.807；95% CI，1.107-2.947；P = 0.018），而 LBBB 与 30 天全因死亡率无关。在这一多变量 Cox 回归模型中，乳酸（HR，1.065；95% CI，1.018-1.115；p = 0.006）、肌钙蛋白 I（HR，1.003；95% CI，1.001-1.005；p = 0.001）和急性生理学评分（HR，1.033；95% CI，1.001-1.066；p = 0.041）与 30 天全因死亡率同样相关。最后，RBBB与肝功能衰竭或严重肾功能衰竭的发生率没有关联：结论：除了急性生理学评分、乳酸和肌钙蛋白水平外，RBBB还与连续CS患者30天全因死亡率增加有关，无论患者是否发生心脏骤停，而LBBB对预后没有影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.