title: Value of the Electrocardiogram as a Predictor of Right Ventricular Dysfunction in Patients With Chronic Right Ventricular Volume Overload.
abstract: OBJECTIVE
  Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation.
  
  
  METHODS
  We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads.
  
  
  RESULTS
  We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with right ventricular volume. The receiver operating characteristic curve indicated a cut-off point for QRS width of 140ms, which showed good sensitivity for a diagnosis of right ventricular dilation (> 80%) and dysfunction (> 95%). In logistic regression models, a QRS duration > 140ms was found to be the only independent predictor of right ventricular dilation and dysfunction.
  
  
  CONCLUSIONS
  Electrocardiography is a rapid, widely available, and reproducible tool. QRS width constitutes an independent predictor of the presence of right ventricular dilation and dysfunction. This study is the first to provide a cutoff value for QRS width to screen for right ventricle involvement.
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: pau_i_au@hotmail.com.
authors.forename: Pau
authors.initials: P
authors.lastname: Alonso
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Andrés
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rueda
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Buendía
authors.affiliation: ERESA, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Igual
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Rodríguez
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Osa
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arnau
authors.affiliation: Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
mesh_terms: D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011665:Pulmonary Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013318:Stroke Volume; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D016278:Ventricular Function, Right / Q000502:physiology*
keywords: Fragmentación; Fragmentation; Insuficiencia pulmonar; Pulmonary regurgitation; QRS; Tetralogy of Fallot; Tetralogía de Fallot