What is the clinical evidence from this study?

Study design: Case-Control. Population: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) (n=84). Intervention: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) vs. Healthy controls. Primary outcome: Correlation of total QRS amplitude (∑QRStot) with right-ventricular end-diastolic diameter (RVEDD) (RC -0.14, 95% CI -0.245 to -0.037, p=0.009).

September 9, 2013Open Access

Right‐Ventricular Enlargement in Arrhythmogenic Right‐Ventricular Cardiomyopathy Is Associated with Decreased QRS Amplitudes and T‐Wave Negativity

RZRobbert ZusterzeelUnited States Food and Drug Administration RBRachel M.A. ter BekkeElectrophysiology PVPaul G.A. VoldersElectrophysiology

Key Result

In patients with arrhythmogenic right-ventricular cardiomyopathy, right ventricular dilatation was significantly associated with lower total QRS amplitudes (RC -0.14) and precordial T-wave inversion.

Study Design

Type

Case-Control (n=84)

Multicenter

Structured PICO

Are specific electrocardiographic characteristics (decreased QRS amplitudes and T-wave negativity) associated with right ventricular dilatation in patients with arrhythmogenic right-ventricular cardiomyopathy?

Population

84 adults (42 with Arrhythmogenic Right-Ventricular Cardiomyopathy [ARVC] and 42 age- and gender-matched healthy controls), mean age 46, 74% male, based in The Netherlands. Excluded: patients with right bundle branch block.

Intervention

12-lead electrocardiography to measure QRS amplitudes in extremity and precordial leads, S amplitude in lead V1, and extent of T-wave inversion

Comparator

Age- and gender-matched healthy controls evaluated for unexplained dyspnea, palpitations or atypical chest complaints, showing a normal twelve-lead ECG and echocardiographic examination

Outcome

Correlation of electrocardiographic characteristics (QRS amplitudes, S amplitude in V1, T-wave inversion) with right ventricular end-diastolic diameter (RVEDD) measured by echocardiographysurrogate

In patients with ARVC, decreased QRS amplitudes and extensive precordial T-wave inversion on a standard 12-lead ECG are significantly associated with right ventricular enlargement.

Main Result

Effect estimate: RC -0.14 (95% CI -0.245 to -0.037)

p-value: p=0.009

Limitations

Cross-sectional design lacking serial ECGs and echocardiographic examinations
Retrospective character with data spanning from 1994 to 2012
Small sample size
Large variation in QRS amplitudes
Intra- and interobserver variability and potential confounders were not addressed

Abstract

BACKGROUND: Arrhythmogenic right-ventricular cardiomyopathy (ARVC) can lead to RV dilatation. We hypothesized that electrocardiographic characteristics including QRS amplitudes in the extremity- and precordial leads, the S amplitude in lead V1 , and extent of T-wave negativity over the precordial leads are related to RV dilatation in this condition. METHODS: In 42 ARVC patients and 42 controls, we correlated total QRS amplitude in the extremity leads (∑QRSext ), precordial leads (∑QRSprec ) and in all leads (∑QRStot : summation of ∑QRSext and ∑QRSprec ), S amplitude in lead V1 and the extent of T-wave inversion in the precordial leads (V1 vs. beyond V1 ) with RV end diastolic diameter (RVEDD) by echocardiography. RESULTS: In the ARVC group, the mean age was 46 ± 14 years, 31 patients were male, 28 had an implantable cardioverter defibrillator (ICD), and 7 had a LV ejection fraction (EF) < 55%. The control group was age- and gender matched to the ARVC cohort. In contrast to controls, the ∑QRSext (regression coefficient (RC), -0.29; P = 0.020), ∑QRSprec (RC, -0.20; P = 0.015), and ∑QRStot (RC, -0.14; P = 0.009) were lower with RV dilatation in ARVC. S amplitude in lead V1 was not related to RV diameter (RC, -0.98; P = 0.088). Precordial T-wave inversion beyond lead V1 (V2 -V6 ) was associated with a larger RV diameter (RC, 8.58; P = 0.012). CONCLUSIONS: Summed QRS amplitudes in the extremity and precordial leads, and T-wave inversion beyond lead V1 are associated with RV dilatation in patients with ARVC.

Ask AI

Helpful

Bookmark

View Full Paper