QRS prolongation is associated with associated with adverse cardiac remodeling in hypertrophic cardiomyopathy

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of electrocardiology Pub Date : 2024-11-01 DOI:10.1016/j.jelectrocard.2024.153818

Hernan L. Vera-Sarmiento , Talha Tanriverdi , David Hurtado-de-Mendoza , Sanjay Sivalokanathan , Ramses Ramirez Damera , Dolores Ketty , Daiyin Lu , Stefan Zimmerman , Sunil Sinha , Melvin Scheinman , M. Roselle Abraham

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引用次数: 0

Abstract

Background

Signal-averaged electrocardiogram (SAECG) records myocardial depolarization, and can detect inhomogeneous/slow conduction in fibrotic myocardium, which promotes reentrant ventricular arrhythmias (VAs). Hypertrophic cardiomyopathy (HCM) is associated with a high prevalence of cardiac fibrosis and VAs, but abnormal SAECG has low predictive power for VAs. We hypothesized that HCM-specific structural/electrical remodeling underlies this result.

Methods

We tested our hypothesis by retrospectively studying HCM patients (n = 73) who underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging within 12 months of SAECG and 12‑lead ECG. Patients were divided into 2 groups (normal-SAECG, abnormal-SAECG) based on filtered-QRS duration (fQRSd), root-mean-square-voltage (RMS40) and low-amplitude (<40 μV) signal of terminal 40 ms of filtered-QRS (late potentials). Abnormal SAECG was defined as fQRSd > 114 ms, RMS40 < 20 μV or LAS40 > 38 ms.

Results

Abnormal SAECG was seen in ∼50 % of HCM patients (37/73). In the abnormal-SAECG group, 78 % (n = 29) only had prolonged fQRSd, and 22 % (n = 8) had prolonged fQRSd plus late potentials (RMS40 < 20 μV or LAS40 > 38 ms). Mean fQRSd and LAS40 were significantly higher in the abnormal-SAECG group. The abnormal-SAECG group had significantly larger LA size, lower global-LV longitudinal systolic strain/strain rate and early-diastolic strain rate by TTE; higher LV-mass index (LVMI) and LV-scar burden by CMR; higher prevalence of repolarization abnormalities on 12‑lead ECG. LVEF and adverse outcomes (VT/VF, heart failure, death) were similar in the 2 groups. Univariate analysis showed that fQRSd is positively correlated with LVMI, LV-scar mass, and negatively correlated with global-LV early diastolic strain rate.

Conclusions

In HCM, abnormal SAECG is associated with greater structural/electrical LV-remodeling, reflecting a severe global myopathy.

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QRS 间期延长与肥厚型心肌病的不良心脏重塑有关。

背景：信号平均心电图（SAECG）记录心肌除极，可检测出纤维化心肌中的不均匀/慢传导，而纤维化心肌会导致再发性室性心律失常（VAs）。肥厚型心肌病（HCM）与高发病率的心脏纤维化和室性心律失常有关，但异常 SAECG 对室性心律失常的预测能力较低。我们假设，HCM 特异性结构/电重塑是导致这一结果的原因：我们通过回顾性研究在 SAECG 和 12 导联心电图检查后 12 个月内接受经胸超声心动图（TTE）和心脏磁共振（CMR）成像检查的 HCM 患者（n = 73）来验证我们的假设。根据滤波-QRS持续时间（fQRSd）、均方根电压（RMS40）和低振幅（114 ms，RMS40 38 ms）将患者分为两组（正常-SAECG、异常-SAECG）：50%的 HCM 患者（37/73）出现 SAECG 异常。在 SAECG 异常组中，78%（n = 29）仅有 fQRSd 延长，22%（n = 8）有 fQRSd 延长和晚电位（RMS40 38 ms）。异常 SAECG 组的平均 fQRSd 和 LAS40 明显更高。SAECG异常组的LA体积明显增大，TTE显示的全左心室纵向收缩应变/应变率和舒张早期应变率较低；CMR显示的左心室质量指数（LVMI）和左心室瘢痕负荷较高；12导联心电图显示的再极化异常发生率较高。两组患者的 LVEF 和不良后果（VT/VF、心衰、死亡）相似。单变量分析表明，fQRSd与左心室容积指数（LVMI）、左心室瘢痕质量呈正相关，与整体左心室舒张早期应变率呈负相关：结论：在 HCM 患者中，SAECG 异常与更大的左心室结构/电重塑相关，反映了严重的整体肌病。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.