The Diagnostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy: Novel ECG Signs.
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Calò Leonardo, Crescenzi Cinzia, Martino Annamaria, Casella Michela, Romeo Fabiana, Cappelletto Chiara, Bressi Edoardo, Panattoni Germana, Stolfo Davide, Targetti Mattia, Toso Elisabetta, Musumeci Maria Beatrice, Tini Giacomo, Ciabatti Michele, Stefanini Matteo, Silvetti Elisa, Stazi Alessandra, Danza Maria Ludovica, Rebecchi Marco, Canestrelli Stefano, Fedele Elisa, Lanzillo Chiara, Fusco Armando, Sangiuolo Federica Carla, Oliviero Giada, Radesich Cinzia, Perotto Maria, Pieroni Maurizio, Golia Paolo, Mango Ruggiero, Gasperetti Alessio, Autore Camillo, Merlo Marco, de Ruvo Ermenegildo, Russo Antonio Dello, Olivotto Iacopo, Sinagra Gianfranco, Gaita Fiorenzo
Аннотация
OBJECTIVES: This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data.
METHODS: We reviewed data of 54 consecutive ALVC patients (32 men, age 39 ± 15 years) and compared them with 84 healthy controls with normal cardiac magnetic resonance.
RESULTS: T-wave inversion was often noted (57.4%), particularly in the inferior and lateral leads. Low QRS voltages in limb leads were observed in 22.2% of patients. The following novel ECG findings were identified: left posterior fascicular block (LPFB) (20.4%), pathological Q waves (33.3%), and a prominent R-wave in V1 with a R/S ratio ≥0.5 (24.1%). The QRS voltages were lower in ALVC compared with controls, particularly in lead I and II. At receiver-operating characteristic analysis, the sum of the R-wave in I to II ≤8 mm (AUC: 0.909; P < 0.0001) and S-wave in V1 plus R-wave in V6 ≤12 mm (AUC: 0.784; P < 0.0001) effectively discriminated ALVC patients from controls. It is noteworthy that 4 of the 8 patients with an apparently normal ECG were recognized by these new signs. Transmural late gadolinium enhancement was associated to LPFB, a R/S ratio ≥0.5 in V1, and inferolateral T-wave inversion, and a ringlike pattern correlated to fragmented QRS, SV1+RV6 ≤12 mm, low QRS voltage, and desmoplakin alterations.
CONCLUSIONS: Pathological Q waves, LPFB, and a prominent R-wave in V1 were common ECG signs in ALVC. An R-wave sum in I to II ≤8 mm and SV1+RV6 ≤12 mm were specific findings for ALVC phenotypes compared with controls.