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Prognostic value of the electrocardiogram in patients with bicuspid aortic valve disease
Paul M Hendriks1, Zoë A Keuning1, Jan A Kors2
1Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
Insights
Electrocardiogram (ECG) abnormalities are common in bicuspid aortic valve (BAV) patients. A longer PR-interval on ECG may predict a worse prognosis for needing aortic valve replacement or experiencing mortality in BAV individuals.
Area of Science:
- Cardiology
- Medical Diagnostics
- Genetics
Background:
- Bicuspid aortic valve (BAV) is a common congenital heart defect.
- Identifying patients at risk for cardiac events is crucial.
- The prognostic value of electrocardiogram (ECG) in BAV patients is not well-established.
Purpose of the Study:
- To describe ECG parameters in BAV patients.
- To investigate the prognostic value of ECG parameters for cardiac events in BAV patients.
Main Methods:
- Single-center prospective study.
- Included 120 BAV patients without prior aortic valve replacement (AVR).
- Assessed ECG parameters and their association with all-cause mortality and AVR using Cox-proportional hazard analysis.
Main Results:
- 48% of BAV patients had ECG abnormalities.
- A longer PR-interval was associated with worse intervention-free survival (HR 1.02, 95% CI: 1.01-1.04) after adjusting for age.
- Other abnormalities included deviating QRS axis (14%) and LVH (17%).
Conclusions:
- ECG abnormalities are frequent in BAV patients.
- The PR-interval may serve as a prognostic marker for intervention-free survival in BAV patients.
Background:
Identifying bicuspid aortic valve (BAV) patients at risk for cardiac events remains challenging and the role of the electrocardiogram (ECG) has not yet been described. Therefore, this study aims to describe ECG parameters in BAV patients, and investigate their prognostic value.
Methods:
In this single-center prospective study patients with BAV without a prior aortic valve replacement (AVR) were included. Transthoracic echocardiogram and 12‑lead resting-ECG were obtained. Associations between ECG parameters and the composite endpoint of all-cause mortality and AVR were assessed using Cox-proportional hazard analysis.
Results:
120 patients with BAV were included (median age 30 years, 61% male). Median aortic jet velocity was 2.4 m/s [IQR: 1.7-3.4] and 5 patients (4%) had severe aortic regurgitation. All patients were in sinus rhythm. Any ECG abnormality was present in 57 patients (48%). Median PR-interval was 156 [IQR: 138-170] msec. A deviating QRS axis was found in 17 patients (14%) and Cornell criteria for LVH were fulfilled in 20 patients (17%). Repolarization abnormalities were present in 12 patients (10%). Median follow-up duration was 7.0 [6.3-9.8] years, during which 23 patients underwent AVR and 2 patients died. After adjusting for age, a longer PR-interval was associated with worse intervention-free survival (HR 1.02, 95% CI: 1.01-1.04).
Conclusion:
Almost half of the patients with BAV had abnormalities on their ECG. Moreover, the PR-interval may be an interesting prognostic marker for intervention-free survival in BAV patients.
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