GEOMETRIC AND FUNCTIONAL CORRELATES OF ELECTROCARDIOGRAPHIC REPOLARIZATION AND VOLTAGE ABNORMALITIES IN AORTIC REGURGITATION

[摘要] Although electrocardiographic left ventricular hypertrophy is a recognized marker of disease severity in patients with chronic aortic regurgitation, the quantitative relations of repolarization abnormalities and QRS voltage to measurements of cardiac structure and function have not been established. The presence or absence of the strain pattern of repolarization and QRS voltage was compared with echocardiographic and radionuclide cineangiographic findings in 95 adults with severe, pure, chronic aortic regurgitation and no evidence of coronary artery disease. In contrast to 54 patients with normal repolarization, 41 patients with an abnormal repolarization pattern had greater left ventricular end-diastolic and end-systolic dimensions (7.2 .+-. 1.1 versus 6.6 .+-. 0.8 cm, p < 0.002 and 5.2 .+-. 1.2 versus 4.4 .+-. 0.7, p < 0.001, respectively), greater left ventricular mass (431 .+-. 138 versus 303 .+-. 89 pg, p < 0.001), higher end-systolic stress (128 .+-. 46 versus 95 .+-. 27 dynes-cm2.cntdot.103, p < 0.001), lower fractional shortening (28 .+-. 8 versus 34 .+-. 5%, p < 0.001) and lower exercise ejection fraction (39 .+-. 11 versus 51 .+-. 8%, p < 0.001). Multiple logistic regression analysis revealed that left ventricular mass and end-systolic stress were independently related to the presence of repolarization abnormalities (p < 0.005). Among the 73 asymptomatic patients, those with normal repolarization had significantly lower prevalences of fractional shortening < 25% (1 of 45 versus 5 of 27, p < 0.05), left ventricular systolic dimension > 5.5 cm (1 of 45 versus 8 of 27, p < 0.05) and exercise left ventricular ejection fraction < 40% (2 of 38 versus 10 of 24, p < 0.05). Voltage was less strongly related to cardiac structure and function and did not modify inferences based on repolarization findings alone. During a 28 month follow-up period of the initially asymptomatic patients, symptoms developed in only 1 (3%) of 37 with persistently normal repolarization but in 6 (24%) of 25 who initially exhibited or later developed a strain pattern (p < 0.03). These data demonstrate that the strain pattern of repolarization in aortic regurgitation is strongly associated with markedly abnormal end-systolic wall stress, left ventricular mass and left ventricular function. Asymptomatic patients with chronic aortic regurgitation and normal repolarization have a low likelihood of severe functional and geometric abnormalities, whereas asymptomatic patients who have abnormal repolarization have a higher risk of ventricular dilation and dysfunction.

[发布日期] 1987-03-01