Left ventricular electrical remodelling: a review

Area of Science:

• Cardiology
• Biophysics
• Medical Imaging

Background:

• The traditional Voltage Paradigm for diagnosing left ventricular hypertrophy (LVH) via ECG assumes a linear relationship between QRS amplitude and left ventricular mass.
• High-resolution cardiac imaging reveals significant discrepancies, with many anatomic LVH cases showing normal QRS amplitudes and vice versa.

Purpose of the Study:

• To propose a new framework, Left Ventricular Electrical Remodeling (LVER), to replace the term 'ECG-LVH'.
• To incorporate non-spatial determinants affecting ECG signals, such as conduction velocity and fibrosis, into a comprehensive model.

Main Methods:

• The study introduces LVER, encompassing four distinct phenotypes: high QRS amplitude, conduction delay, low QRS amplitudes, and QRS fragmentation.
• This framework is endorsed by leading electrocardiology societies.

Main Results:

• Each LVER phenotype represents a unique electrophysiological substrate.
• These phenotypes provide prognostic information independently of left ventricular mass.

Conclusions:

• LVER offers a more accurate approach to assessing cardiac electrical status than the traditional Voltage Paradigm.
• Reframing the clinical task as electrical risk phenotyping improves patient risk stratification.