Prevalence and significance of T-wave inversion on the electrocardiogram of patients with marfan syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Cardiac risk in the young charity, and Robert Luff Foundation. Background The 12-lead ECG is used as a screening tool in healthy individuals and patient populations, and pathological T-wave inversion (TWI) warrant further investigation for heart disease. Marfan syndrome (MFS) can be associated with valvular disease and a cardiomyopathy-like phenotype but there are limited data on the ECG of this cohort. Purpose We aimed to characterize the ECG of MFS patients, with particular emphasis on the prevalence and significance of TWI. Methods The study population included consecutive MFS patients, aged ≥18 years old, free of cardiothoracic surgery, seen in our Aortopathy clinic between 2015 and 2019. We collected information on demographics, MFS systemic score, body habitus (height, weight and body mass index-BMI), medical treatment and echocardiographic data. Chest deformities were defined as presence of pectus excavatum (PE), pectus carinatum (PC) or chest wall asymmetry (CA). The ECG was systematically analysed based on established criteria. The presence of TWI and its localisation were recorded. Results 116 MFS patients were included (mean age 39±15 years, females 60%, Caucasian 89%, BMI 25±6 Kg/m2). 44% of patients were on beta-blocker. Chest deformities were present in 42% of the patients (PE 18%, PC 22%, CW 2%) and scoliosis in 59% of them. Echocardiography revealed a mean aortic root was 38.1±4.8mm but no evidence of significant cardiomyopathy in any of the patients. Four individuals exhibited moderate mitral regurgitation. ECG abnormalities are summarised in Figure 1. Anterior TWI was present in 10.3%, inferior TWI in 4.3% and lateral in 3.4%. Age, ethnicity, BMI, scoliosis, or valvular pathology were not associated with TWI. However, anterior TWI was more common in females compared to males (14.5% versus 4.3%) and in patients with PE compared to those without (31.3% vs 8%, p=0.003). Conclusion Pathological TWI were present in almost a fifth of MFS patients. Anterior TWI were more frequently present in females and in patients with pectus excavatum and are likely to represent a benign trait. The exact significance of other TWI remains to be elucidated