0352: R wave in AVL lead is a robust index of left ventricular hypertrophy: a cardiac MRI study

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in patient free from overt cardiac disease and conduction disorders, R wave in aVL lead (RaVL) is better correlated than other ECG indexes with left ventricular mass index (LVMI) assessed with transthoracic echocardiography. The aim of this study was to validate RaVL as an index of left ventricular hypertrophy (LVH) using cardiac MRI (CMR) in different conditions. In a cohort of 501 patients, CMR and ECG were performed within a median-period of 5 days. The CMR LVH cut-offs used were 83g/m 2 in men and 67g/m 2 in women. In mutivariable analysis (adjusted for age, left ventricular volume, blood pressure, age and gender), RaVL was correlated with LVMI in the whole cohort and also in patients with or without myocardial infarction (MI): β=0.037, p<0.001; β=0.053, p<0.001; β=0.039, p=0.010, respectively. In the whole cohort, area under ROC curve (AUC) was 0.729 (specificity 98.3%, sensitivity 19.6%, optimal cut-off 1.1 mV, 75.8% correctly classified). In the subgroup without MI (N=300), an optimal value of 1.0 mV classified correctly 80.7% of patients (AUC 0.781, specificity 95.5%, sensitivity 35.5%). In the subgroup with MI (N=201), RaVL had a lower diagnostic performance (AUC 0.673, specificity 97.7%, sensitivity 13.2%, optimal threshold 1.1 mV). We observed the same diagnostic performance of RaVL in women and in men without MI (optimal threshold 1.0 mV, AUC 0.788 and 0.778 respectively).The diagnostic value of RaVL was lower in patients with left bundle branch block (BBB) or left deviation axis in comparison with those having right BBB (optimal threshold 1.0 mV for all, AUC 0.556, 0.753 and 0.933 respectively). Using the gold standard to assess LVMI, our results demonstrated thar RaVL is a good index of LVH with a threshold around 1.0 mV independently of various clinical conditions.