Key result
Standard ECG voltage criteria had poor sensitivity but high specificity for detecting right ventricular hypertrophy in patients with repaired Tetralogy of Fallot and right bundle branch block.
Why the study?
Surgically repaired Tetralogy of Fallot leads to progressive RVH and RVD, but the utility of ECG in evaluating these patients with pre-existing RBBB had not been studied.
Do standard ECG voltage criteria accurately detect ventricular hypertrophy and dilatation compared to cardiac MRI in adults with repaired Tetralogy of Fallot?
Cohort (n=163)
No
Do standard ECG voltage criteria accurately detect ventricular hypertrophy and dilatation compared to cardiac MRI in adults with repaired Tetralogy of Fallot?
Answers are grounded in this paper and cite their sources.
Standard ECG voltage criteria have extremely poor sensitivity for detecting right ventricular hypertrophy in adults with repaired Tetralogy of Fallot and should not be used to monitor these patients.
Background Surgically repaired Tetralogy of Fallot (rTOF) is associated with progressive right ventricular hypertrophy (RVH) and dilation (RVD). Accurate estimation of RVH/ RVD is vital for the ongoing management of this patient population. The utility of the ECG in evaluating patients with rTOF with pre-existing right bundle branch block (RBBB) has not been studied. We aimed to determine the sensitivity/specificity of currently established ECG criteria in detecting RVH/RVD in this patient population. Methods We included consecutive patients diagnosed with rTOF who underwent CMR performed at our regional referral centre between January 2012 and December 2019. Each CMR was assessed for LVH, LVD, RVH or RVD diagnosis. The ECG corresponding to the CMR was then used to determine RVH/LVH for specificity and sensitivity analysis. Results Our study included 163 consecutive rTOF patients. The specificity for ECG-based criteria for LVH was 100.00% (95% C.I. (87.75, 100.00)), and the sensitivity was 7.19% (95% C.I. (3.15, 12.83)). When RBBB was present, specificity for RVH was 100.00% (95% C.I. (84.56, 100.00)), and sensitivity was 7.69% (95% C.I. (3.75, 13.69)). When RBBB was absent, specificity for RVH was 100.00% (95% C.I. (15.81, 100.00)), and sensitivity was 0.00% (95% C.I. (0.00, 33.63)). A regression model with the entire group of 163 ToF patients, based on the Sokolow-Lyon criterion (sum of R in V1 + S in V5/V6), produced a new suggested criterion for the diagnosis of RVH in patients with rTOF, which was a sum of R in V1 + S in V5/V6 greater than 13.25 mm. This model’s sensitivity for RVH detection was 69.1%, and specificity was 36.8%. Conclusions Standard ECG voltage criteria have poor sensitivity for detecting right and left ventricular chamber hypertrophy and dilatation in patients with rTOF, so current ECG criteria should not be used to monitor RVH/RVD in this patient population.
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Brar et al. (2023) conducted a cohort in Repaired Tetralogy of Fallot (n=163). Standard ECG voltage criteria vs. Cardiac MRI was evaluated on Sensitivity of ECG criteria for detecting right ventricular hypertrophy in the presence of right bundle branch block (Sensitivity 7.69%, 95% CI 3.75-13.69). Standard ECG voltage criteria had poor sensitivity but high specificity for detecting right ventricular hypertrophy in patients with repaired Tetralogy of Fallot and right bundle branch block.
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