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. 2019 Dec;8(2):253-265.
doi: 10.1007/s40119-019-0141-6. Epub 2019 Jul 17.

Implications of Left Bundle Branch Block in Takotsubo Cardiomyopathy: Propensity Match Analysis from the National Inpatient Sample

Dipesh Ludhwani  1 , Mouyyad Rahaby  2 , Vasu Patel  2 , Saad Jamil  2 , Adam Kedzia  2 , Chunyi Wu  3
Affiliations

Implications of Left Bundle Branch Block in Takotsubo Cardiomyopathy: Propensity Match Analysis from the National Inpatient Sample

Dipesh Ludhwani et al. Cardiol Ther. 2019 Dec.

Abstract

Introduction: Takotsubo cardiomyopathy (TTC), also called stress cardiomyopathy, is a transient reversible left ventricular dysfunction mimicking acute coronary syndrome (ACS). Studies have shown similar rates of in-hospital complications in TTC and myocardial infarction (MI). Left bundle branch block (LBBB) is associated with increased mortality in patients with MI; however, similar studies comparing outcomes of TTC in the presence of LBBB are lacking.

Methods: The 2016 National Inpatient Sample (NIS) database was queried to identify all admissions with a primary discharge diagnosis of TTC. Diagnosis-specific codes were used to stratify patients based on the presence or absence of LBBB. Both population sets were paired using 1:10 propensity score matching. Multivariate logistic regression analysis was performed to compare various in-hospital outcomes among both groups.

Results: Amongst 7270 admissions for TTC, 226 patients had concomitant LBBB. After performing 1:10 propensity matching, 130 patients with LBBB were compared to 1275 patients without LBBB. The presence of LBBB was associated with increased odds of cardiogenic shock (AOR = 2.2, 95% CI 1.21-3.99, p = 0.0097); ventricular arrhythmia (AOR 1.99, 95% CI 1.11-3.57, p = 0.02), acute congestive heart failure (AOR = 1.49, 95% CI 1.01-2.2, p = 0.04), and sudden cardiac arrest (AOR = 3.37, 95% CI 1.59-7.13, p = 0.0001). There was no statistical difference in all-cause in-hospital mortality, however a trend towards worsening was noted.

Conclusions: The incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.

Keywords: Arrhythmia; Conduction disorders; Left bundle branch block; Stress cardiomyopathy; Takotsubo cardiomyopathy.

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Conflict of interest statement

Dipesh Ludhwani, Mouyyad Rahaby, Vasu Patel, Saad Jamil, Adam Kedzia and Chunyi Wu have nothing to disclose.

Figures

Fig. 1
Fig. 1
Annual trend of all hospitalizations related to takotsubo cardiomyopathy and left bundle branch block. The Y-axis shows the rates per 100,000 admissions
Fig. 2
Fig. 2
Forrest plot graph showing adjusted odds ratio for various in-hospital outcomes before calculating propensity score. AOR adjusted odds ratio, LCL lower confidence limit, UCL upper confidence limit
Fig. 3
Fig. 3
Forrest plot graph showing adjusted odds ratio for various in-hospital outcomes after calculating propensity score. AOR adjusted odds ratio, LCL lower confidence limit, UCL upper confidence limit
See this image and copyright information in PMC

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