Effect of left bundle branch block on maximal functional capacity in asymptomatic individuals without structural heart disease

IF 4.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Revista española de cardiología (English ed.) Pub Date : 2025-11-01 Epub Date: 2025-03-21 DOI:10.1016/j.rec.2025.03.001

Patricia Palau , Eloy Domínguez , Silvia Mínguez , Gonzalo Núñez , Enrique Santas , Celia García-Conejo , Iván de Amo , Paloma Marín , Cristina Flor , Laura López , Lucía Ortega , Isabel Gabaldón-Sánchez , Rafael de la Espriella , Juan Sanchis , Julio Núñez

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Abstract

Introduction and objectives

In asymptomatic individuals, left bundle branch block (LBBB) is associated with an increased risk of cardiovascular events, but its impact on maximal functional capacity remains unclear. This study aimed to evaluate maximal aerobic capacity (peakVO₂) in asymptomatic adults with LBBB without structural heart disease and compare it to an age-, physical activity-, and sex-matched control population.

Methods

This prospective case-control study included asymptomatic adults with isolated LBBB and matched controls. All participants underwent maximal cardiopulmonary exercise testing and echocardiography. The primary outcome was to compare peakVO₂ and percent predicted peakVO₂ (pp-peakVO₂) between LBBB and matched controls. Secondary outcomes included differences in left ventricular indexed end-diastolic volumes (iLVEDV) and left ventricular ejection fraction (LVEF). Multivariate linear mixed models were used to analyze primary and secondary outcomes.

Results

A total of 162 participants (81 with LBBB and 81 controls) were included. The mean age was 65.7 ± 10.2 years, and 106 participants (65.4%) were women. The mean pp-peakVO₂ and peakVO₂ were 93.6 ± 16.9% and 19.9 ± 6.4 mL/kg/min, respectively. There were no significant differences in cardiovascular risk factors, NT-proBNP, or hemoglobin values between groups. Multivariate analysis showed that the presence of LBBB was associated with lower peakVO₂ (−3.3 mL/kg/min, 95%CI, − 4.6 to − 2.1; P < .001) and pp-peakVO₂ (−17.2%; 95%CI, −22.1 to −11.9; P < .001). Regarding secondary endpoints, individuals with LBBB showed higher iLVEDV (+4.4 mL/m², 95%CI, 1.3 to 7.6; P = .006) and lower LVEF (−2.8%, 95%CI, −4.3 to −1.2; P < .001) compared with controls.

Conclusions

In this study, adults with isolated LBBB showed reduced maximal functional capacity compared with controls.

Registered at ClinicalTrials.gov (NCT05643404).

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无结构性心脏病患者左束支阻滞对最大功能容量的影响。

简介和目的：在无症状个体中，左束分支阻滞（LBBB）与心血管事件风险增加有关，但其对最大功能容量的影响尚不清楚。本研究旨在评估无结构性心脏病的无症状LBBB成人的最大有氧能力（峰值vo2），并将其与年龄、体力活动和性别匹配的对照人群进行比较。方法：这项前瞻性病例对照研究包括无症状的孤立性下脑屏障成人和匹配的对照组。所有参与者都进行了最大心肺运动测试和超声心动图检查。主要结果是比较LBBB和匹配对照之间的峰值vo2和预测峰值vo2百分比（pp-峰值vo2）。次要结局包括左室指数舒张末期容积（iLVEDV）和左室射血分数（LVEF）的差异。多变量线性混合模型用于分析主要和次要结局。结果：共纳入162名参与者（81名LBBB患者和81名对照组）。平均年龄65.7±10.2岁，女性106例（65.4%）。平均pp-peakVO2和peakVO2分别为93.6±16.9%和19.9±6.4 mL/kg/min。两组间心血管危险因素、NT-proBNP或血红蛋白值无显著差异。多因素分析显示，LBBB的存在与较低的峰值vo2相关(-3.3mL/kg/min, 95%CI, -4.6 ~ -2.1；p2 (-17.2%；95%CI, -22.1 ~ -11.9；P 2, 95%CI, 1.3 ~ 7.6；P = .006)和低LVEF(-2.8%, 95%置信区间,-4.3 - -1.2;结论：在这项研究中，与对照组相比，孤立性下脑屏障的成年人表现出最大功能能力的降低。在ClinicalTrials.gov注册（NCT05643404）。

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