Guido Vannoni MD, Carlos D. Labadet MD, Giuliana Caminotti MD, Bárbara Zambudio MD, Juan M. Fiamengo Tch, Lucas N. Campana MD, María V. Vannoni MD, Gerardo M. Marambio MD, Jorge A. Lax MD, Juan A. Gagliardi MD, PhD
{"title":"完全性左束支传导阻滞患者左轴极值偏移的价值。","authors":"Guido Vannoni MD, Carlos D. Labadet MD, Giuliana Caminotti MD, Bárbara Zambudio MD, Juan M. Fiamengo Tch, Lucas N. Campana MD, María V. Vannoni MD, Gerardo M. Marambio MD, Jorge A. Lax MD, Juan A. Gagliardi MD, PhD","doi":"10.1016/j.cpcardiol.2025.103174","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Complete left bundle branch block (LBBB) is associated with increased risk of cardiovascular events. The value of extreme deviation of the QRS axis to the left (LAD) in the context of LBBB is controversial.</div></div><div><h3>Objective</h3><div>To evaluate whether LAD (-45°) in patients with LBBB is a marker of systolic dysfunction and ventricular remodeling.</div></div><div><h3>Material and methods</h3><div>Cross-sectional cohort study including 102 patients with LBBB who underwent echocardiography to assess left ventricular (LV) diameters, wall thickness and ejection fraction (EF).</div></div><div><h3>Results</h3><div>Mean age was 67.9 ± 13 years. 48 % were women. 80.4 % met Strauss criteria for LBBB and 28.4 % had LAD. The LAD group showed lower EF (32.2 ± 12 % vs. 46.7 ± 17 %, p = 0.00009) and higher LV end-diastolic diameter index (34.8 ± 9 vs. 30.9 ± 6, p = 0.011). LAD had 45 % sensitivity, 88 % specificity, positive predictive value of 0.79 and negative predictive value of 0.62 for identifying reduced EF. Cardiomyopathy diagnosis was more frequent in the LAD group (93.1 % vs. 61.6 %; p = 0.0016). LV hypertrophy prevalence was similar between groups, but LAD patients had higher prevalence of eccentric LV hypertrophy.</div></div><div><h3>Conclusion</h3><div>In LBBB, LAD (-45°) identifies patients with worse systolic function, greater degree of LV dilatation, and more eccentric hypertrophy. Additionally, cardiomyopathy prevalence was higher in this population.</div></div>","PeriodicalId":51006,"journal":{"name":"Current Problems in Cardiology","volume":"50 11","pages":"Article 103174"},"PeriodicalIF":3.3000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Value of extreme left axis deviation in patients with complete left bundle branch block\",\"authors\":\"Guido Vannoni MD, Carlos D. Labadet MD, Giuliana Caminotti MD, Bárbara Zambudio MD, Juan M. Fiamengo Tch, Lucas N. Campana MD, María V. Vannoni MD, Gerardo M. Marambio MD, Jorge A. Lax MD, Juan A. Gagliardi MD, PhD\",\"doi\":\"10.1016/j.cpcardiol.2025.103174\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Complete left bundle branch block (LBBB) is associated with increased risk of cardiovascular events. The value of extreme deviation of the QRS axis to the left (LAD) in the context of LBBB is controversial.</div></div><div><h3>Objective</h3><div>To evaluate whether LAD (-45°) in patients with LBBB is a marker of systolic dysfunction and ventricular remodeling.</div></div><div><h3>Material and methods</h3><div>Cross-sectional cohort study including 102 patients with LBBB who underwent echocardiography to assess left ventricular (LV) diameters, wall thickness and ejection fraction (EF).</div></div><div><h3>Results</h3><div>Mean age was 67.9 ± 13 years. 48 % were women. 80.4 % met Strauss criteria for LBBB and 28.4 % had LAD. The LAD group showed lower EF (32.2 ± 12 % vs. 46.7 ± 17 %, p = 0.00009) and higher LV end-diastolic diameter index (34.8 ± 9 vs. 30.9 ± 6, p = 0.011). LAD had 45 % sensitivity, 88 % specificity, positive predictive value of 0.79 and negative predictive value of 0.62 for identifying reduced EF. Cardiomyopathy diagnosis was more frequent in the LAD group (93.1 % vs. 61.6 %; p = 0.0016). LV hypertrophy prevalence was similar between groups, but LAD patients had higher prevalence of eccentric LV hypertrophy.</div></div><div><h3>Conclusion</h3><div>In LBBB, LAD (-45°) identifies patients with worse systolic function, greater degree of LV dilatation, and more eccentric hypertrophy. Additionally, cardiomyopathy prevalence was higher in this population.</div></div>\",\"PeriodicalId\":51006,\"journal\":{\"name\":\"Current Problems in Cardiology\",\"volume\":\"50 11\",\"pages\":\"Article 103174\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2025-09-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Current Problems in Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0146280625001938\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Current Problems in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0146280625001938","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Value of extreme left axis deviation in patients with complete left bundle branch block
Introduction
Complete left bundle branch block (LBBB) is associated with increased risk of cardiovascular events. The value of extreme deviation of the QRS axis to the left (LAD) in the context of LBBB is controversial.
Objective
To evaluate whether LAD (-45°) in patients with LBBB is a marker of systolic dysfunction and ventricular remodeling.
Material and methods
Cross-sectional cohort study including 102 patients with LBBB who underwent echocardiography to assess left ventricular (LV) diameters, wall thickness and ejection fraction (EF).
Results
Mean age was 67.9 ± 13 years. 48 % were women. 80.4 % met Strauss criteria for LBBB and 28.4 % had LAD. The LAD group showed lower EF (32.2 ± 12 % vs. 46.7 ± 17 %, p = 0.00009) and higher LV end-diastolic diameter index (34.8 ± 9 vs. 30.9 ± 6, p = 0.011). LAD had 45 % sensitivity, 88 % specificity, positive predictive value of 0.79 and negative predictive value of 0.62 for identifying reduced EF. Cardiomyopathy diagnosis was more frequent in the LAD group (93.1 % vs. 61.6 %; p = 0.0016). LV hypertrophy prevalence was similar between groups, but LAD patients had higher prevalence of eccentric LV hypertrophy.
Conclusion
In LBBB, LAD (-45°) identifies patients with worse systolic function, greater degree of LV dilatation, and more eccentric hypertrophy. Additionally, cardiomyopathy prevalence was higher in this population.
期刊介绍:
Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.