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Electrocardiographic assessment of LVH in aortic stenosis patients: how well does it correlate with myocardial mass?
Session:
Posters (Sessão 1 - Écran 5) - Doença Vascular e Cirurgia Cardíaca
Speaker:
Ana Rita Bello
Congress:
CPC 2022
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
26. Cardiovascular Surgery
Subtheme:
15.6 Valvular Heart Disease – Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Rita Bello; João Abecasis; Sérgio Maltês; Rita Reis Santos; Gustavo sá Mendes; Carla Reis; Luís Oliveira; Sara Guerreiro; Pedro Freitas; António Ferreira; Nuno Cardim; Victor Gil; Miguel Mendes
Abstract
<p style="margin-right:-38px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Aortic stenosis (AS) is a well-known cause of left ventricle hypertrophy (LVH) due to chronic pressure overload. While imaging techniques remain the gold-standard in determining myocardial mass, electrocardiogram (EKG) may also help in assessing LVH and remodeling. Our goal was to determine the correlation between LVH criteria by EKG, echocardiogram (TTE) and cardiac magnetic resonance (CMR).</span></span></p> <p style="text-align:justify"> </p> <p style="margin-right:-38px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methods</u>: Single-center prospective study enrolling patients with severe symptomatic high-gradient AS undergoing surgical aortic valve replacement with no previous known cardiomyopathy. All patients performed EKG, TTE and CMR prior to surgery. Those with bundle branch block were excluded. LVH was defined by an index left ventricular mass higher than 115g/m<sup>2</sup> (male) or 95g/m<sup>2</sup> (female) by TTE or >85g/m<sup>2</sup> (male) or 68g/m<sup>2</sup> (female) by CMR. LVH by EKG was determined by the presence of at least one of the following: positive Cornell (R wave aVL + S wave V3 ≥28mm [male] or ≥20mm [female]) or Sokolow-Lyon (S wave V1 + R wave V5/V6 ≥35mm) criteria; Romhilt–Estes score ≥5. Diagnostic accuracy was determined for each criteria. EKG strain pattern (downsloping convex ST segment and/or inverted asymmetrical T wave) and fragmented QRS ([fQRS] - defined as the presence of various RSR´ patterns with different QRS morphologies) were compared with LVH, AS severity and LV function indexes. </span></span></p> <p style="margin-right:-42px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: A total of 135 patients were included (age 71±8y; 47% male; median transaortic gradient [AVmean] 58 [47-69]mmHg; mean LV ejection fraction [LVEF] by TTE and CMR 58±9% and 60±11%, respectively). Overall, 118 patients (83%) and 60 patients (42%) met LVH criteria by TTE and CMR. EKG sensitivity and specificity regarding LVH (by CMR) were as follows: 57% and 86% (Sokolow-Lyon); 60% and 76% (Cornell); 57% and 86% (</span>Romhilt–Estes). Those with EKG strain pattern (n=56, 41%) had <span style="color:#222222">lower LVEF by TTE and CMR, worse global longitudinal strain and worse myocardial work efficiency – see </span><strong><span style="color:#4472c4">figure 1</span></strong><span style="color:#222222">. No differences were observed among those with (n=29, 21%) or without fQRS.</span></span></span></p> <p style="margin-right:-42px; text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: In a cohort of severe symptomatic high-gradient AS, EKG criteria had a low sensitivity but moderate-to-high specificity in identifying those with CMR-confirmed LVH. EKG strain pattern may be an adjunctive tool to identify patients with possible advanced LV functional impairment in this setting.</span></span></span></p> <p> </p>
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