Left ventricular function-conduction impairment as reflected by the ECG in chronic aortic regurgitation

Abstract

The study was conducted to ascertain that the ECG assists in the assessment of systolic dysfunction in chronic aortic regurgitation. Five variables were reviewed in 146 adults without bundle branch block who underwent angiocardiography: total 12-lead QRS amplitude, QRS duration, maximum R peak time in I, V5 or V6, maximum R peak time relative to S peak time of the maximum S in V1, V2 or V3, and maximum T wave amplitude and polarity in I, V6 or aVF. In order to define which of them could differentiate left ventricular ejection fraction (EF) ≥50% (n = 101) from EF <50% (n = 45) they were subjected to stepwise linear discriminant analysis. The maximum R peak time relative to S peak time emerged as the most promising variable. In predicting EF <50%, R peak time prolongation exceeding S peak time, i.e. R peak delay, yields reliable results, with specificity, positive and negative predictive value being 89.1%, 70.3% and 82.6%, respectively, and sensitivity being 57.8%. As given by the sample odds-ratio, R peak delay indicates an 11-fold increased risk of having EF <50%. R peak delay, a marker of left ventricular function-conduction impairment identifies patients who need valve replacement.

Electrocardiographic Predictors of Heart Failure With Reduced Versus Preserved Ejection Fraction: The Multi‐Ethnic Study of Atherosclerosis

“…Delayed time to ID is thought to represent conduction delay secondary to increases in left ventricular cavity size and increases in left ventricular end‐diastolic volume 31, 32. Similarly, abnormalities of left ventricular repolarization possibly detect structural abnormalities that predispose to HFrEF rather than HFpEF 29, 33, 34.…”

“…Delayed time to ID is thought to represent conduction delay secondary to increases in left ventricular cavity size and increases in left ventricular end-diastolic volume. 31,32 Similarly, abnormalities of left ventricular repolarization possibly detect structural abnormalities that predispose to HFrEF rather than HFpEF. 29,33,34 This is supported by data that have shown that ST/T-wave abnormalities are not associated with diastolic dysfunction that would be expected in the development of HFpEF 35 .…”

Electrocardiographic Time to Intrinsicoid Deflection and Heart Failure: The Multi‐Ethnic Study of Atherosclerosis

“…This is supported by a recent examination of 146 adults with aortic insufficiency that found delayed ID to be highly predictive of a reduced ejection fraction (<50%) with a specificity of 89.1% (16). Additionally, delayed ID has been shown to suggest volume overload (e.g., increased left ventricular end-diastolic volume) in patients with chronic mitral regurgitation (17).…”

The Effectiveness of a Deep Learning Model to Detect Left Ventricular Systolic Dysfunction from Electrocardiograms

“…Previous studies have identified ECG predictors of LV dysfunction as LV hypertrophy, left bundle branch block, prolongation of QRS duration, axial deviation, and R-peak delay, which was defined as the R-peak time in lead V5 or V6 exceeding the S-peak time in leads V1, V2, and V3. 27,28) The metabolic or structural changes associated with cardiomyopathic processes, such as cardiomyocyte hypertrophy, inflammation, and fibrosis, would result in ECG changes 29) . For example, prolongation of QRS duration and R-peak delays reflect ventricular depolarization abnormalities arising from conduction delays that are the result of increased LV end-diastolic volume.…”

“…For example, prolongation of QRS duration and R-peak delays reflect ventricular depolarization abnormalities arising from conduction delays that are the result of increased LV end-diastolic volume. 29,30) These changes may have been detected by the developed model as changes in the QRS complex on ECG.…”