Electrocardiographic observations in clinically isolated, pure, chronic, severe aortic regurgitation: Analysis of 30 necropsy patients aged 19 to 65 years

Abstract

Certain electrocardiographic findings are described in 30 necropsy patients with clinically isolated pure, chronic, severe aortic regurgitation. They were 19 to 65 years old (mean 45). The hearts of the 22 men ranged in weight from 430 to 1,110 g (mean 717) and of the 8 women, from 375 to 950 g (mean 638). Four had grossly visible left ventricular (LV) scars. All but 1 patient was in sinus rhythm. The PR interval was >0.20 second in 8 patients (28%) and the QRS duration was >0.12 second in 6 patients (20%). Only 5 patients (17%) had 1 or more ventricular premature complexes recorded on the resting electrocardiogram analyzed. The mean QRS amplitude for each of the 12 leads averaged 23 mm. The highest mean QRS voltage occurred in leads V 2 and V 3 (each 38 mm), and the lowest in lead aVR (11 mm). The mean QRS voltage in V 5 was higher than in V 6 (33 vs 28 mm) and in 22 patients (73%) the QRS voltage in V 5 was higher than in V 6. The sum of the S wave in V 1 plus the larger of the R wave in V 5 or V 6 (Sokolow-Lyon index) averaged 51 mm and in only 22 patients (73%) was it >35 mm. The Romhilt-Estes voltage criteria for LV hypertrophy was fulfilled even less frequently, despite the severe degrees of LV hypertrophy in the patients studied. The total 12-lead QRS amplitude in the 30 patients ranged from 109 to 428 mm (mean 272) (10 mm = 1 mV) and in 27 patients (90%) it was >175 mm. The ratio of total 12-lead QRS voltage to heart weight in the 30 patients with aortic regurgitation was 0.42, only slightly higher than that in previously studied adults with severe aortic stenosis (0.39), an observation indicating that cavity dilatation does not magnify the QRS voltage generated by a given mass of myocardium.