title: Electrocardiographic characteristics indicating a risk of irreversibly impaired myocardial function in chronic aortic regurgitation.
abstract: In order to define which of selected ECG variables could indicate irreversibly impaired myocardial function in chronic aortic regurgitation 54 patients were stratified according to normal (> or = 50%; Group A, n = 41) or subnormal radionuclide left ventricular ejection fraction (LVEF < 50%; Group B, n = 13) late after aortic valve replacement. Preoperatively, Group B patients had a significantly greater QRS duration, greater R-peak time (RPT) prolongation in I, V5 or V6, greater RPT relative to the S-peak time of the maximum S in V1, V2 or V3 (R-peak delay) and a greater negative T-wave in I or V6, as compared with Group A. These ECG variables together with preoperative angiocardiographic LVEF and end-systolic volume index were subjected to stepwise linear discriminant analysis. The maximum RPT, angio-LVEF and the maximum RPT relative to the S-peak time of the maximum S in V1, V2 or V3 emerged as the most promising variables. Of of Group A patients 82.9% and 84.6% of Group B patients were correctly classified by the three variables. If applied separately, APT prolongation or the presence of the R-peak delay in the left-sided leads, although less sensitive, have reasonably high specificity as risk indicators of irreversibly impaired chamber function, their positive predictive value being 60 and 62.5%, respectively. In conjunction with preoperative LVEF the diagnostic contribution of the two ECG variables amounts to the greatest overall separation of postoperatively preserved from irreversibly impaired systolic function.
authors.affiliation: University Heart Centre, University of Erlangen, Nuremberg, Germany.
authors.forename: S H
authors.initials: SH
authors.lastname: Recke
authors.forename: J
authors.initials: J
authors.lastname: Marienhagen
authors.forename: H
authors.initials: H
authors.lastname: Feistel
authors.forename: G
authors.initials: G
authors.lastname: Platsch
authors.forename: E
authors.initials: E
authors.lastname: Bock
authors.forename: J
authors.initials: J
authors.lastname: von der Emde
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D002908:Chronic Disease; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015635:Radionuclide Ventriculography; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*