Association Between Left Anterior Fascicular Block, Cardiac Remodeling, and Carotid Intima Media Thickness in Hypertensive Patients.
Essential hypertension is associated with structural and functional cardiac changes, including left ventricular hypertrophy (LVH), which significantly increases cardiovascular risk. Left anterior fascicular block (LAFB), historically considered benign, has recently been linked to adverse outcomes. Carotid intima-media thickness (CIMT) is a noninvasive marker of subclinical atherosclerosis. The interplay between LAFB, LVH, and CIMT in hypertensive patients remains poorly defined.
We conducted a cross-sectional study of 256 patients with essential hypertension, divided into LAFB (n = 60) and non-LAFB (n = 196) groups. All participants underwent 12-lead electrocardiography, echocardiography, and carotid ultrasonography. CIMT was measured as a surrogate of vascular remodeling. Echocardiographic indices of cardiac remodeling and CIMT were compared between groups. Logistic regression identified independent predictors of LAFB.
Patients with LAFB had significantly higher left atrial diameter (LAD), left atrial volume index (LAVI), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass (LVM), left ventricular mass index (LVMI), and prevalence of LVH compared with those without LAFB (all p < 0.001). Mean CIMT values were also greater in the LAFB group (0.82 ± 0.27 vs. 0.72 ± 0.19 mm, p = 0.003). ROC analysis identified LAD >35 mm and LVMI >81 g/m2 as useful predictors of LAFB. Multivariate logistic regression showed increased LAD (OR = 7.94, 95% CI: 2.24-28.10, p = 0.001) and LVM (OR = 3.37, 95% CI: 1.49-7.57, p = 0.003) as independent predictors of LAFB.
In essential hypertension, LAFB is associated with more advanced cardiac remodeling and increased CIMT. LAD and LVM were independent predictors of LAFB, suggesting that this ECG finding may serve as a simple marker of higher cardiovascular risk.
We conducted a cross-sectional study of 256 patients with essential hypertension, divided into LAFB (n = 60) and non-LAFB (n = 196) groups. All participants underwent 12-lead electrocardiography, echocardiography, and carotid ultrasonography. CIMT was measured as a surrogate of vascular remodeling. Echocardiographic indices of cardiac remodeling and CIMT were compared between groups. Logistic regression identified independent predictors of LAFB.
Patients with LAFB had significantly higher left atrial diameter (LAD), left atrial volume index (LAVI), interventricular septal thickness (IVST), posterior wall thickness (PWT), left ventricular mass (LVM), left ventricular mass index (LVMI), and prevalence of LVH compared with those without LAFB (all p < 0.001). Mean CIMT values were also greater in the LAFB group (0.82 ± 0.27 vs. 0.72 ± 0.19 mm, p = 0.003). ROC analysis identified LAD >35 mm and LVMI >81 g/m2 as useful predictors of LAFB. Multivariate logistic regression showed increased LAD (OR = 7.94, 95% CI: 2.24-28.10, p = 0.001) and LVM (OR = 3.37, 95% CI: 1.49-7.57, p = 0.003) as independent predictors of LAFB.
In essential hypertension, LAFB is associated with more advanced cardiac remodeling and increased CIMT. LAD and LVM were independent predictors of LAFB, suggesting that this ECG finding may serve as a simple marker of higher cardiovascular risk.
Authors
Yetim Yetim, Kalçık Kalçık, Bekar Bekar, Çelik Çelik, Sarıhan Sarıhan, Karavelioğlu Karavelioğlu
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