TY - JOUR
T1 - Electrocardiographic predictors of right ventricular volume measured by magnetic resonance imaging late after total repair of tetralogy of fallot
AU - Book, Wendy M.
AU - Parks, W. James
AU - Hopkins, Katherine L.
AU - Hurst, J. Willis
PY - 1999
Y1 - 1999
N2 - Background: Right ventricular dysfunction occurs in many patients with significant pulmonary valve regurgitation late after initial total repair of tetralogy of Fallot. Methods to predict which of these patients are at increased risk of late morbidity and mortality are not yet known. Hypothesis: This study evaluated electrocardiographic (ECG) predictors of severe right ventricular dilatation determined by magnetic resonance imaging (MRI) volumes in patients with tetralogy of Fallot late after initial corrective repair. Methods: We retrospectively reviewed the ECGs and MRI right ventricular volume measurements of 20 patients (age 4.4 to 19.3 years, mean 10.0 years) with significant pulmonary valve regurgitation late after repair of tetralogy of Fallot. All patients had enlarged, hypokinetic right ventricles by echocardiography. The patients were grouped based on an indexed fight ventricular end-diastolic volume (RVEDV/BSA) of < 102 ml/m2 (Group 1) or ≥102 ml/m2 (Group 2). We determined the sensitivity, specificity, positive and negative predictive values of QRS duration, and mean frontal plane QRS axis for predicting right ventricular volumes. Results: A maximal QRS duration of ≥ 150 ms or a northwest quadrant frontal plane ORS axis had 85% sensitivity, 86% specificity, 92% positive predictive value, and 75% negative predictive value for predicting an RVEDV/BSA of ≥102 ml/m2. The mean QRS duration was significantly longer in Group 2 than in Group 1 patients (156 ms vs. 123 ms, p = 0.005). Conclusions: In patients late after repair of tetralogy of Fallot with significant pulmonary valve regurgitation, a maximal manually measured QRS duration of ≥ 150 ms and/or a frontal plane QRS northwest quadrant axis can predict patients with marked fight ventricular enlargement. The presence of either of these findings on the ECG signifies patients who require further evaluation and consideration for pulmonary valve replacement.
AB - Background: Right ventricular dysfunction occurs in many patients with significant pulmonary valve regurgitation late after initial total repair of tetralogy of Fallot. Methods to predict which of these patients are at increased risk of late morbidity and mortality are not yet known. Hypothesis: This study evaluated electrocardiographic (ECG) predictors of severe right ventricular dilatation determined by magnetic resonance imaging (MRI) volumes in patients with tetralogy of Fallot late after initial corrective repair. Methods: We retrospectively reviewed the ECGs and MRI right ventricular volume measurements of 20 patients (age 4.4 to 19.3 years, mean 10.0 years) with significant pulmonary valve regurgitation late after repair of tetralogy of Fallot. All patients had enlarged, hypokinetic right ventricles by echocardiography. The patients were grouped based on an indexed fight ventricular end-diastolic volume (RVEDV/BSA) of < 102 ml/m2 (Group 1) or ≥102 ml/m2 (Group 2). We determined the sensitivity, specificity, positive and negative predictive values of QRS duration, and mean frontal plane QRS axis for predicting right ventricular volumes. Results: A maximal QRS duration of ≥ 150 ms or a northwest quadrant frontal plane ORS axis had 85% sensitivity, 86% specificity, 92% positive predictive value, and 75% negative predictive value for predicting an RVEDV/BSA of ≥102 ml/m2. The mean QRS duration was significantly longer in Group 2 than in Group 1 patients (156 ms vs. 123 ms, p = 0.005). Conclusions: In patients late after repair of tetralogy of Fallot with significant pulmonary valve regurgitation, a maximal manually measured QRS duration of ≥ 150 ms and/or a frontal plane QRS northwest quadrant axis can predict patients with marked fight ventricular enlargement. The presence of either of these findings on the ECG signifies patients who require further evaluation and consideration for pulmonary valve replacement.
KW - Congenital heart disease
KW - Fight bundle-branch block
KW - Right ventricle
KW - Ventricular dysfunction
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U2 - 10.1002/clc.4960221113
DO - 10.1002/clc.4960221113
M3 - Article
C2 - 10554690
AN - SCOPUS:0032713834
SN - 0160-9289
VL - 22
SP - 740
EP - 746
JO - Clinical Cardiology
JF - Clinical Cardiology
IS - 11
ER -