Abstract 9814: Clinical Characteristics and Outcomes in Patients With Congestive Heart Failure and Low Voltage 12-Lead Ecg

Abstract

Background: Low voltage ECG (LowV-ECG) pattern is defined as a peak-to-peak QRS amplitude of less than 5mm in the limb leads and/or less than 10mm in the pericardial leads. It can occur in many cardiac conditions associated with congestive heart failure (CHF), such as ischemic cardiomyopathy (ICM), cardiac amyloidosis (CA), hemochromatosis (HC), and hypothyroidism (HT). The clinical significance of LowV-ECG abnormalities in CHF patients has not been well investigated. Methods: Clinical, echocardiographic, and ECG data was collected in 460 consecutive CHF patients with non-V-paced rhythms enrolled over 2 years in the Get With the Guidelines Heart Failure (GWG-HF) registry at a single academic tertiary center. ECGs were reviewed for the presence of low QRS voltage and additional ECG features classically reported in ICM, CA, HC, and HT. Results: LowV-ECG was noted in 8.5% patients (39/460) of the study cohort, and was more common in females, 11.6% (25/216) vs. 5.7% (14/244) in males, p=0.025. LowV-ECG patients had increased BMI (34.9+/-12.8 vs. 31.1+/-9 kg/m2, p=0.016) and more commonly had a history of DM (12.2% vs.5.5%, p=0.01). There were no significant differences in age, GFR, or presence of CAD, hypertension or Afib. Prevalence of HFrEF, HFmrEF, and HFpEF in patients with LowV-ECG was 6.8, 10, and 9.8%, respectively, p=0.506. With regards to the ECG features typically associated with cardiac amyloidosis, poor R-wave progression was more common in LowV-ECG patients, 41% (16/39) vs.13.5% (57/421) in the rest of the cohort, p<0.001, but there was no significant difference in prevalence of pseudo-infarct pattern, 15.4% (6/39) vs. 10.5% (44/421), p=0.344, or in prevalence of LBBB or incomplete LBBB or non-specific IVCD, 15.4% (6/39) vs. 17.3% (73/421), p=0.164. After 70.7+/-25.2 months follow-up, Low-V ECG was not associated with increased mortality (12.8% vs. 20.4%, p=0.253). Rates of 30, 60, and 90-day readmissions were not increased. Conclusions: Among patients admitted with a CHF diagnosis, low voltage ECG pattern was more commonly seen in females, overweight patients, and in patients with diabetes. Low voltage ECG patients did not display additional ECG features typical of cardiac amyloidosis and did not experience adverse short- or long-term outcomes.