You are here

  • Home
  • Archive
  • Volume 88, Issue 3
  • ECG determinants in adult patients with chronic right ventricular pressure overload caused by congenital heart disease: relation with plasma neurohormones and MRI parameters

Article Text

Article menu
Download PDFPDF
Congenital heart disease
ECG determinants in adult patients with chronic right ventricular pressure overload caused by congenital heart disease: relation with plasma neurohormones and MRI parameters
  1. J G J Neffke1,
  2. I I Tulevski1,
  3. E E van der Wall3,
  4. A A M Wilde1,
  5. D J van Veldhuisen4,
  6. A Dodge-Khatami2,
  7. B J M Mulder1
  1. 1Department of Cardiology, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
  2. 2Department of Cardiothoracic Surgery, Academic Medical Centre Amsterdam, Amsterdam, Netherlands
  3. 3Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
  4. 4Department of Cardiology, University Hospital Groningen, Groningen, Netherlands
  1. Correspondence to:
    Dr B J M Mulder, Department of Cardiology, Room B2–240, Academic Medical Centre Amsterdam (AMC), Meibergdreef 9, 1100 DD Amsterdam, Netherlands;
    b.j.mulder{at}amc.uva.nl

Abstract

Objective: To examine retrospectively the changes in ECG parameters over time and their correlation with other quantitative right ventricular (RV) function parameters in patients with chronic RV pressure overload caused by congenital heart disease.

Methods: 48 patients with chronic RV pressure overload caused by the following congenital heart diseases were studied: nine with congenitally corrected transposition of the great arteries (TGA), 12 with surgically corrected TGA, and 27 with a subpulmonary pressure overloaded RV. QRS duration and dispersion were measured manually from standard ECG recorded twice within five years. RV end diastolic volume (EDV) and RV mass were determined by magnetic resonance imaging. Brain natriuretic peptide (BNP) plasma concentrations were measured.

Results: QRS duration and QRS dispersion increased in all patient groups during the follow up period. QRS duration increased significantly in the congenitally corrected TGA (p = 0.04) and the subpulmonary pressure overloaded RV groups (p = 0.01). QRS dispersion increased significantly in patients with surgically corrected TGA (p = 0.03) and in the subpulmonary pressure overloaded RV group (p = 0.02). A significant correlation was found between QRS duration and RVEDV (r = 0.71, p < 0.0001). RV mass was significantly correlated with QRS duration in patients with tetralogy of Fallot (r = 0.67, p = 0.01). Mean (SD) plasma brain natriuretic peptide concentrations (6.6 (5.4) pmol/l) were increased compared with normal reference values but no correlation was found with ECG parameters or RV systolic pressure. No malignant arrhythmia or sudden death occurred.

Conclusions: ECG parameters worsened gradually in asymptomatic or minimally symptomatic patients with chronic RV pressure overload, regardless of the nature of their congenital heart disease. In all patients, a significant positive correlation was found between QRS duration and RVEDV. In patients with tetralogy of Fallot there was also a correlation between QRS duration and RV mass.

  • congenital heart disease
  • ECG parameters
  • magnetic resonance imaging
  • brain natriuretic peptide
  • BNP, Brain natriuretic peptide
  • EDV, end diastolic volume
  • MRI, magnetic resonance imaging
  • RV, right ventricular
  • SVT, supraventricular tachycardia
  • TGA, transposition of the great arteries
  • VT, ventricular tachycardia

https://doi.org/10.1136/heart.88.3.266

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes