The Diagnostic and Prognostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy.
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Calò Leonardo, Crescenzi Cinzia, Di Marco Andrea, Fanisio Francesca, Romeo Fabiana, Gargaro Alessio, Martino Annamaria, Cappelletto Chiara, Merlo Marco, Targetti Mattia, Toso Elisabetta, Toto Federica, Musumeci Maria Beatrice, Tini Giacomo, Ciabatti Michele, Stefanini Matteo, Canestrelli Stefano, Fedele Elisa, Lanzillo Chiara, Fusco Armando, Sangiuolo Federica Carla, Radesich Cinzia, Perotto Maria, Pieroni Maurizio, Mango Ruggiero, Gasperetti Alessio, Autore Camillo, Casella Michela, Dello Russo Antonio, Stolfo Davide, Laredo Mikael, Gandjbakhch Estelle, Graziosi Maddalena, Biagini Elena, Catalano Costantina, Barile Ludovica, Drago Fabrizio, Cicenia Marianna, Baban Anwar, Pelargonio Gemma, Narducci Maria Lucia, Re Federica, Peretto Giovanni, Paiotti Elena, Díez-López Carles, Olivotto Iacopo, Gaita Fiorenzo, Sinagra Gianfranco, Novelli Giuseppe
Аннотация
OBJECTIVES: The authors aimed to analyze the electrocardiogram (ECG) characteristics of ALVC, to correlate ECG with cardiac magnetic resonance and genetic data, and to evaluate its prognostic value.
METHODS: We reviewed data of 125 consecutive patients with ALVC (81.5% desmoplakin pathogenic/likely pathogenic variants). The composite endpoint of major arrhythmic events (MAEs) included sudden cardiac death, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator shock. Predictors of MAE were evaluated with logistic regression.
RESULTS: ALVC showed distinct ECG signs, including left posterior fascicular block (LPFB) (13.6%), pathological Q waves (26.4%), R/S ratio in V1 ≥0.5 (26.4%), and SV1 + RV6 ≤12 mm and RI + RII ≤8 mm (44%). Fifteen (12%) patients had a normal ECG. MAE occurred in 35 patients (28%). In multivariable analysis, LPFB (OR: 4.7; 95% CI: 1.2-18.3), syncope (OR: 84.95; 95% CI: 14-496), transmural late gadolinium enhancement (OR: 9.95; 95% CI: 2.3-36), and right ventricular ejection fraction (OR: 0.92; 95% CI: 0.87-0.97) were the independent predictors of MAE. The model including these 4 variables achieved a remarkable predictive capability (area under the curve: 0.9). In the primary prevention scenario, with Cox regression, LPFB (HR: 3.98; 95% CI: 1.3-12.0), syncope (HR: 19.13; 95% CI: 5.8-63.0), and transmural late gadolinium enhancement (HR: 10.57; 95% CI: 2.9-38.0) were independent predictors of MAE.
CONCLUSIONS: In ALVC, ECG is a valuable diagnostic tool and may have a relevant prognostic role, since LFPB is a strong and independent predictor of MAE.