PS-C24-5: PEGUERO LO PRESTI CRITERIA MODIFIED BY QRS DURATION AS PREDICTOR OF HFPEF IN HYPERTENSIVE PATIENTS

Abstract

Objectives: ECG markers as a predictor for heart failure (HF) with preserved ejection fraction (HFpEF) are not specific, however hypertension is the most common comorbid cause of HFpEF. A recent study found Cornell Product (CP) can be an ECG marker for HFpEF but has low sensitivity and specificity. Peguero Lo Presti is an LVH criterion with good sensitivity compared to other criteria. Since increasing LV mass also prolongs QRS duration, the Peguero Lo Presti modified with QRS (PMQ) duration can potentially be a good ECG marker for HFpEF. Aim of this study was to find out the relationship between PMQ ECG parameters and HfpEF, also finding the optimal cutoff in predicting HFpEF. Design and method: This study was a cohort retrospective using medical records that include ECG and Echo data of hypertensive patients at Sanglah General Hospital from 2018 until 2022, and 190 patients were enrolled. Subjects were divided into hypertensive patients who develop in to HFpEF and non develop in to HFpEF. Subjects with IVCD were excluded. PMQ is defined: (S wave amplitude in V4 + deepest S amplitude in any precordial lead) x QRS duration. The Mann-Whitney test was used to compare the mean ECG parameters and mean echocardiographic parameters between the HFpEF and non-HFpEF groups. An optimal cutoff value for PMQ and CP to predict the develop of HFpEF was evaluated using receiver operating characteristics (ROC). Results: Based on data, subjects with HFpEF were 52.1%, and non-HFpEF was 47.9%. The HFpEF group had higher LVMI (136.13 ± 34.55vs76.23 ± 14.11), higher mean E/E’ (16.97 ± 6.71vs13.25 ± 2.62), higher LAVI (52.46 ± 42.63vs28.97 ± 6.95) with all p-value < 0.05. On ECG parameters, the HFpEF group had a significantly longer QTc duration (486.53 ± 75.78vs437.33 ± 24.08), higher CP outcome (1823.6 ± 429.6vs1476.9 ± 273.8), and higher PMQ outcome (2919.8 ± 732.8 vs 2097.9 ± 535.2) with better sensitivity and specificity of PMQ cutoff than CP (PMQ > 2655, sensitivity 54.2%, specificity 92.6% vs CP > 1770, sensitivity 36.5%, specificity 91.5%). Subjects with a cutoff of PMQ (> 1770ms) were also significantly associated with HFpEF (PR 1.773; 95%CI 1.170–2.687; P < 0.001). Conclusion: Modified Peguero Lo Presti by QRS duration is an easy-to-apply ECG marker for HFpEF and has relatively good sensitivity and specificity reflecting the severity of diastolic dysfunction and LV hypertrophy.