Major Left Bundle Branch Block and Coronary Heart Disease-Are There Any Differences between the Sexes?

Diana Gurzău,Gabriel Cismaru,Dana Pop,Alexandra Dădârlat-Pop,Bogdan Caloian,Raluca Tomoaia,Dumitru Zdrenghea,Horaţiu Comşa

doi:10.3390/jcm10112284

Abstract

Left bundle branch block is not a benign pathology, and its presence requires the identification of a pathological substrate, such as ischemic heart disease. Left bundle branch block appears to be more commonly associated with normal coronary arteries, especially in women. The objectives of our study were to describe the particularities of left bundle branch block in women compared to men with ischemic heart disease. Result: We included seventy patients with left bundle branch block and ischemic heart disease, with a mean age of 67.01 ± 8.89 years. There were no differences in the profile of risk factors, except for smoking and uric acid. The ventricular depolarization (QRS) duration was longer in men than women (136.86 ± 8.32 vs. 132.57 ± 9.19 msec; p = 0.018) and also men were observed to have larger left ventricular diameters. Left bundle branch block duration was directly associated with ventricular diameters and indirectly associated with left ventricular ejection fraction value, especially in women (R = −0.52, p = 0.0012 vs. R = −0.50, p = 0.002). In angiography, 80% of women had normal epicardial arteries compared with 65.7% of men; all these patients presented with microvascular dysfunction. Conclusion: The differences between the sexes were not so obvious in terms of the presence of risk factors; instead, there were differences in electrocardiographic, echocardiographic, and angiographic aspects. Left bundle branch block appears to be a marker of microvascular angina and systolic dysfunction, especially in women.

Highlights

The presence of left bundle branch block (LBBB), extensively studied, is still associated with many gaps in the knowledge of its development mechanism and underlying associated diseases
There are very few studies regarding the presence of LBBB in women with ischemic heart disease, in the case of microvascular involvement. In this context, the objectives of the current study were to describe certain particularities of LBBB in women compared to men with ischemic heart disease, especially from the point of view of echocardiography and coronary angiography
The study included seventy patients admitted to the Cardiology Department of the Clinical Rehabilitation Hospital, Cluj-Napoca, Romania, with major LBBB detected on the resting electrocardiogram recorded on the first day of admission and symptoms highly suggestive of myocardial ischemia

Summary

Introduction

The presence of left bundle branch block (LBBB), extensively studied, is still associated with many gaps in the knowledge of its development mechanism and underlying associated diseases. Major left bundle branch block is not a benign electrophysiological condition. On the contrary, it almost always has an underlying disease: hypertension, left ventricular hypertrophy, cardiomyopathies, valvulopathies, heart failure, or ischemic heart disease. Most of the time, LBBB is associated with myocardial ischemia, through both obstructive coronary artery disease and microvascular involvement, or with coronary vasospasm. Electrocardiographic recording of this conduction disorder in a suggestive clinical context requires establishing the diagnosis of coronary disease or even acute myocardial infarction. New-onset LBBB associated with an increase in myocardial necrosis enzyme levels defines the diagnosis of acute myocardial infarction, according to the European Society of Cardiology [3]

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