title: Electrocardiographic QRS duration reflects right ventricular remodeling in patients undergoing corrective surgery for isolated tricuspid regurgitation: a comparative study with cardiac magnetic resonance imaging.
abstract: BACKGROUND
  The role of electrocardiogram (ECG) is unclear for the longitudinal follow-up of patients who undergo corrective surgery for isolated severe tricuspid regurgitation (TR).
  
  
  OBJECTIVE
  This study sought to investigate the usefulness of changes in QRS duration of ECG after TR surgery in predicting right ventricular (RV) reverse remodeling as determined by cardiac magnetic resonance imaging (CMR).
  
  
  METHODS
  We enrolled 30 consecutive TR patients (27 women, aged 57.8 ± 9.6 years) who had undergone prior left-sided valve surgery. A computer-assisted analysis was performed for objective calculation of QRS duration before and after surgery.
  
  
  RESULTS
  At a median CMR follow-up of 27.5 months postsurgery, QRS duration was cut by 14.6%, from 110.4 ± 14.6 msec to 96.9 ± 11.9 msec (P < 0.001), while CMR showed a decrease in RV end-diastolic volume index (RV-EDVI) from 179.5 ± 59.7 to 119.1 ± 30.4 mL/m(2) (P < 0.001). QRS duration correlated significantly with RV-EDVI and RV end-systolic volume index (r = 0.65, P < 0.001 and r = 0.53, P < 0.001, respectively), and a percent change in QRS duration was significantly correlated with a percent change in RV-EDVI (r = 0.40, P = 0.03). When significant RV reverse remodeling was defined as a reduction in RV-EDVI ≥20% following TR surgery, the sensitivity and specificity for significant RV reverse remodeling were 75% and 78%, respectively, with a 9% reduction in QRS duration (P = 0.01, area underneath the receiver operator curve [AUC] = 0.81).
  
  
  CONCLUSIONS
  The extent of changes in postoperative QRS duration can be used as a useful, inexpensive, and simple index reflecting the occurrence of significant RV reverse remodeling in patients undergoing corrective TR surgery.
authors: Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors: Myung-Ki
authors: MK
authors: Seo
authors: Eun-Ah
authors: EA
authors: Park
authors: Hyung-Kwan
authors: HK
authors: Kim
authors: Whal
authors: W
authors: Lee
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Kyung-Hwan
authors: KH
authors: Kim
authors: Ki-Bong
authors: KB
authors: Kim
authors: Dae-Won
authors: DW
authors: Sohn
authors: Hyuk
authors: H
authors: Ahn
authors: Jae-Hyung
authors: JH
authors: Park
mesh_terms: D000200:Action Potentials; D000368:Aged; D019540:Area Under Curve; D006348:Cardiac Surgical Procedures; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D016278:Ventricular Function, Right; D020257:Ventricular Remodeling