Abstract
Introduction: Left ventricular (LV) interstitial diffuse fibrosis and scar (replacement fibrosis) affect ventricular depolarization and repolarization parameters on an electrocardiogram (ECG) through local electrophysiology as well as LV global structure. The aim of this study is to examine the association between the two different types of fibrosis and ECG indices. Methods: A total of 1,669 participants (aged 54 to 94 years, 50% women) free of prior myocardial infarction or conduction delay underwent cardiac magnetic resonance with late gadolinium enhancement (LGE), and 1,136 participants without an LGE-defined scar were analyzed using T1 mapping. The associations of LV diffuse fibrosis or scar with ECG parameters [QRS Sokolow-Lyon and Cornell voltage, QRS duration, and corrected QT (QTcorr) interval] were evaluated using multivariable regression analyses adjusted for cardiovascular risk factors, LV end-diastolic volume, and LV mass. Results: Lower post-contrast T1 time at 12 min and 25 min, indicating greater diffuse fibrosis, was significantly associated with lower QRS Sokolow-Lyon voltage, lower QRS Cornell voltage, and shorter QRS duration (all P<0.05). Greater extracellular volume fraction (ECV) was also significantly associated with lower QRS Sokolow-Lyon voltage (β=-38.9, P<0.001) and Cornell voltage (β=-23.5, P<0.001). By contrast, the presence of LV scar (n=106) was associated with longer QTcorr interval (β=4.2, P=0.034). Conclusions: In middle-aged multi-ethnic population, LV diffuse fibrosis assessed by T1 mapping was significantly associated with lower QRS voltage and shorter QRS duration, whereas LV scar was associated with longer QT interval; independent of cardiovascular risk factors and LV structure. Our results reveal the potential of 12-lead ECG of evaluating two different type of fibrosis.
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