Electrocardiographic observations in severe aortic valve stenosis: Correlative necropsy study to clinical, hemodynamic, and ECG variables demonstrating relation of 12-lead QRS amplitude to peak systolic transaortic pressure gradient

Abstract

Most ECG studies in patients with aortic valve stenosis (AS) have involved living patients in whom the status of the left ventricular (LV) myocardium, epicardial coronary arteries, and mitral valve was not precisely known. We examined the 12-lead ECG recorded within 2 months of death in 50 patients aged 16 to 65 years (mean 48) with peak systolic pressure gradients (PSPG) across the aortic valve ranging from 52 to 180 mm Hg (mean 98) and anatomically normal mitral valves. Excluding four patients with complete left bundle branch block (LBBB), 44 (96%) of the other 46 patients had the usual voltage criteria for LV hypertrophy (LVH). Measurement of the total 12-lead QRS amplitude, which ranged from 144 to 417 mm (10 mm = 1 mV), (mean 257) proved useful for it correlated directly with PSPG across the aortic valve and, when the four LBBB patients were excluded, with the peak LV systolic pressure. The total 12-lead QRS amplitude (mm) was similar in most patients to the LV systolic pressure (mm Hg). Thus, subtraction of the indirect systemic arterial systolic pressure (mm Hg) from the total 12-lead QRS amplitude (mm) provides a reasonable noninvasive prediction of the PSPG across the aortic valve in patients with moderate to severe AS. Additionally, the mean of the total 12-lead QRS amplitude was significantly ( p < 0.05) greater in the 11 younger (≤ 40 years) than in the 39 older patients (278 mm vs 257 mm), in the 14 women than in the 36 men (277 mm vs 249 mm), in the 22 patients with heavier (> 600 gm) hearts (274 mm vs 244 mm), in the 34 patients without compared to the 16 with significant coronary arterial narrowing (270 mm vs 238 mm), and in the 22 patients without compared to the 24 with ECG myocardial damage patterns (269 mm vs 236 mm).