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Relationship of ventricular conduction defects, angiographic findings and mortality in cardiogenic shock

Session Rapid Fire 1 - Acute heart failure

Speaker Tuija Sabell

Event : Heart Failure 2016

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure– Treatment
  • Session type : Rapid Fire Abstracts

Authors : T Javanainen (Helsinki,FI), H Tolppanen (Helsinki,FI), MS Nieminen (Helsinki,FI), J Lassus (Helsinki,FI), A Sionis (Barcelona,ES), J Spinar (Brno,CZ), M Banaszewski (Warsaw,PL), V-P Harjola (Helsinki,FI), R Jurkko (Helsinki,FI)

Authors:
T Javanainen1 , H Tolppanen1 , MS Nieminen2 , J Lassus2 , A Sionis3 , J Spinar4 , M Banaszewski5 , V-P Harjola6 , R Jurkko2 , 1Helsinki University Central Hospital, Heart and Lung Center - Helsinki - Finland , 2Helsinki University Central Hospital, Heart and Lung Center, Division of Cardiology - Helsinki - Finland , 3Hospital de la Santa Creu i Sant Pau, Intensive Cardiac Care Unit, Cardiology Department - Barcelona - Spain , 4University Hospital Brno, Department of Internal Medicine and Cardiology - Brno - Czech Republic , 5Institute of Cardiology, Intensive Cardiac Therapy Clinic - Warsaw - Poland , 6Helsinki University Central Hospital, Division of Emergency Care, Department of Medicine - Helsinki - Finland ,

On behalf: the CardShock study investigators and GREAT network

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2016 ) 18 ( Supplement 1 ), 23

Background: Ventricular conduction defects, such as bundle branch blocks, hemiblocks and non-specific intraventricular conduction defects (IVCD), are frequently present in cardiogenic shock (CS), but their relationship with angiographic findings and mortality is not clear. Purpose: The aim of this study was to investigate whether ventricular conduction abnormalities are associated with specific angiographic findings and increased mortality. Methods: We analysed the baseline electrocardiogram (ECG) of patients who underwent angiography in a multinational prospective cohort study of CS (n = 219) conducted in 2010-2012 with one-year follow-up. In total 182 (83.1%) patients underwent angiography. The baseline ECG was available for 164 (74.8%) of these patients. The patients with ventricular conduction defects (n = 80; 48.8%) were compared with those who had other ECG pattern (n = 84; 51.2%). The multivariate models were calculated with logistic regression adjusted for age, previous myocardial infarction and the CardShock risk score. The risk score takes into account age, confusion at presentation, previous myocardial infarction or coronary artery bypass graft, acute coronary artery syndrome aetiology, left ventricle ejection fraction, serum lactate and estimated glomerular filtration rate. Results: Nearly half of the patients had a ventricular conduction defect (LBBB 2.4%, RBBB 12.2%, LAHB 14.6%, LPHB 3.7% or non-specific IVCD 15.9%). Most of the patients had significant coronary artery stenosis (n = 152; 92.7%) and the prevalence did not differ between the groups (95.0% vs 90.5%; p = 0.27). In the patients with conduction defects the culprit lesion was more often in the left main (LM) coronary artery (25.0% vs. 9.5%; p = 0.008). There was no difference between the groups in three vessel disease (25.0% vs. 32.1%; p = 0.31) or in the finding of TIMI flow grade 0 (64.9% vs 71.6%; p = 0.38). One-year mortality was higher in patients with ventricular conduction defects (Figure). In the multivariate model ventricular conduction defects independently predicted mortality (OR 1.79; 95% CI 1.07-3.01; p = 0.027). When we further adjusted mortality rates for the prevalence of the LM coronary artery disease, ventricular conduction defects were still an independent predictor of mortality (OR 1.73; 95% CI 1.02-2.93; p = 0.043). Conclusions: In CS ventricular conduction defects in baseline ECG are associated with increased mortality and higher incidence of the LM coronary artery disease. However conduction abnormalities do not associate with three vessel disease or TIMI flow grade 0. Conduction defects are an independent risk factor also after eliminating the effect of LM disease. This study suggests that in CS ventricular conduction abnormalities predict mortality regardless of the severity of the coronary artery disease.

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