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CLEAR FILTERS
Left Ventricular remodelling in aortic stenosis: prediction from ECG criteria
Session:
Painel 9 - Doença Valvular 1
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2020
Topic:
G. Aortic Disease, Peripheral Vascular Disease, Stroke
Theme:
22. Aortic Disease
Subtheme:
22.3 Aortic Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Gustavo Sá Mendes; João Abecasis; Maria Salomé Carvalho; António Miguel Ferreira; Maria João Andrade; Carla Reis; Telma Lima; Victor M. Gil; José Pedro Neves; Miguel Mendes
Abstract
<p><strong>Background:</strong> Left ventricular hypertrophy (LVH) and remodelling in patients with severe aortic stenosis (AS) is mainly characterized by imaging tools. Electrocardiography may provide distinct criteria for LVH, strain and fibrosis from QRS fragmentation (fQRS) but their accuracy has not been well described yet.</p> <p><strong>Aim:</strong> To describe the accuracy of distinct ECG criteria for LVH and remodelling in patients with severe aortic stenosis.</p> <p><strong>Methods: </strong>We prospectively studied 53 consecutive patients (age: 71±8years [min. 51, max.84 years], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Mean transaortic pressure gradient was 54.6 mmHg [IQR 46.6-63.2] and aortic valve area was 0.74cm<sup>2 </sup>[IQR 0.61-0.89)]. LVH criteria [Sokolow-Lyon index, Cornell voltage, Romhilt-Estes Score (RE)], strain pattern (downsloping convex ST segment and/or inverted asymmetrical T wave, opposite to main QRS deflection) and fQRS (defined as the presence of various RSR´ patterns with different QRS morphologies) were assessed by two independent readers and compared with LVH and indexes of remodelling as assessed by both echocardiography and CMR. Aortic stenosis severity and LV function indexes were also compared in two groups of patients, with and without ECG strain markers.</p> <p><strong>Results: </strong>LVH was present in 93% of men and 88% of women as assessed by echocardiography (median M-mode mass 155g/m<sup>2</sup> [IQR 127-209]) and 85% of men and 50% of women by CMR (median LV mass 76.5g/m<sup>2</sup> [IQR 57.4-94.8]). CMR geometric remodelling was more prevalent than LVH [92.3% of men and 86.4% of women; median 0.94g/mL (IQR 0.83-1.04)]. Patients with LHV ECG criteria (positive SL, C and RES) had statistically higher LV mass (104.5 vs 76.5g/m2, p=0.015). SL index and Cornell criteria had the best sensitivity for LV mass (55.1% for both) and SL the highest specificity (68.4%).</p> <p>42% of the patients had one or two ECG strain markers and their presence were both related to higher transvalvular mean gradients, higher E/e´ ratio, lower global longitudinal strain, increased LV mass and lower ejection fraction (table 1).</p> <p>ECG fragmentation was present in 22% of the patients, 73% of them with no other ECG abnormalities. This pattern was significantly related to the presence of delayed enhancement at CMR (83% vs. 27%, p=0.034) and the percentage of fibrosis (8.1% vs 3.9 %, p=0.049).</p> <p><strong>Conclusions: </strong>ECG criteria for LVH have poor accuracy in identifying LVH by CMR in patients with severe aortic stenosis. However, ECG strain may identify more advanced stages of the disease as assessed by higher LV mass and worse indexes of LV function. As for other clinical contexts, fQRS is related to the presence of myocardial fibrosis in this group of patients.</p>
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