The relationship between electrocardiographic left ventricular hypertrophy criteria and echocardiographic mass in patients undergoing transcatheter aortic valve replacement

Abstract

Introduction: Calcific aortic stenosis (AS) is a common valvular disease among the elderly. Often, AS leads to left ventricular hypertrophy (LVH) and symptoms of heart failure. Severe AS can be treated by transcatheter aortic valve replacement (TAVR). Previous studies have shown that electrocardiogram (ECG) criteria for LVH correlate poorly with left ventricular mass (LVM) in echocardiography. However, such correlations have not been studied in TAVR patients.

Aims: To evaluate ECG LVH criteria as a method of diagnosing and quantifying LVH in patients with AS undergoing TAVR.

Material and methods: Twenty-four patients, with neither pacemaker nor bundle branch block, who had undergone pre-TAVR ECG and echocardiography were included. The ECGs were evaluated using the Sokolow-Lyon, Romhilt-Estes and Cornell Voltage criteria for LVH as well as spatial maximal QRS-T angle and 3D QRS maximal spatial vector. The LVM was measured by echocardiography.

Results: 15 (63%) patients met the echocardiographic threshold for LVH. 7 patients (29%) were positive by the Sokolow-Lyon, 5 (21%) by the Romhilt-Estes and 12 (50%) by the Cornell Voltage criteria for LVH. There was no correlation between LVM and conventional ECG LVH criteria or spatial parameters. QRS duration correlated with LVM (r=0.56, R(2)=0.31, p=0.005). However, there was no correlation between QRS duration and LVM index or relative wall thickness (RWT).

Conclusions: In TAVR patients, none of the ECG LVH criteria should be used for evaluation of LVM. QRS duration is moderately correlated to LVM and is the most useful ECG estimate of LVM.

Keywords: Aortic stenosis; Echocardiography; Electrocardiography; Left ventricular hypertrophy; Transcatheter aortic valve replacement.