title: The relationship between electrocardiographic left ventricular hypertrophy criteria and echocardiographic mass in patients undergoing transcatheter aortic valve replacement.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To evaluate ECG LVH criteria as a method of diagnosing and quantifying LVH in patients with AS undergoing TAVR.
  
  
  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.
authors: Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Duke University, Durham, NC, USA.
authors: Siri
authors: S
authors: Sjöberg
authors: Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors: Frida
authors: F
authors: Sundh
authors: Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden; Nicollier-Schlegel SARL, Trélex, Switzerland.
authors: Todd
authors: T
authors: Schlegel
authors: University of Washington, Seattle, WA, USA.
authors: Charles
authors: C
authors: Maynard
authors: Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors: Andreas
authors: A
authors: Rück
authors: Duke University, Durham, NC, USA.
authors: Galen
authors: G
authors: Wagner
authors: Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden. Electronic address: martin.ugander@gmail.com.
authors: Martin
authors: M
authors: Ugander
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: Aortic stenosis; Echocardiography; Electrocardiography; Left ventricular hypertrophy; Transcatheter aortic valve replacement