Coronary Angiographic Patterns and Clinical Correlates in Patients with Electrocardiographic Evidence of Left Bundle Branch Block

Abstract

Objectives: Left bundle branch block (LBBB) poses significant diagnostic challenges due to its frequent association with coronary artery disease (CAD), hypertension, and structural heart disease. Noninvasive diagnostic tools are often unreliable in the presence of LBBB, making coronary angiography the gold standard for assessment. To evaluate the coronary angiographic patterns and associated risk factors in patients with electrocardiographic evidence of LBBB. Methodology: This descriptive, cross-sectional study was conducted at the Cardiology Department, Lady Reading Hospital, Peshawar, between January 10, 2023, and July 9, 2023. A total of 120 patients with ECG-confirmed LBBB underwent detailed clinical evaluation, echocardiography, and coronary angiography. Risk factors and angiographic findings were recorded, and data were analyzed using SPSS version 25. Results: Among the 120 patients (mean age 54.2 ± 7.8 years; 65% male), hypertension (50%) and diabetes mellitus (13.4%) were the most common comorbidities. Echocardiography revealed reduced ejection fraction in 66.6% of cases. Coronary angiography showed normal coronary anatomy in 43.3% of patients. Among those with CAD, triple-vessel disease was predominant (30%), while single-vessel and double-vessel disease were observed in 16.7% and 6.7% of patients, respectively. The left anterior descending (LAD) and right coronary artery (RCA) were the most frequently involved vessels (10% each). Patients with CAD demonstrated significantly lower ejection fractions compared to those with normal angiograms (p < 0.05). Conclusion: LBBB in the study population was most strongly associated with hypertension. While nearly half of the patients exhibited normal coronary anatomy, the presence of CAD was frequently extensive, with triple-vessel involvement and reduced left ventricular function. These findings emphasize the importance of selective coronary angiography and echocardiographic assessment in the diagnostic evaluation of patients presenting with LBBB.