Background and Hypothesis: LV hypertrophy (LVH) due to critical aortic stenosis is expected in the TAVR patients. In a patient with a murmur and suspected aortic stenosis, absence of LVH by ECG criteria may suggest less severe aortic valve disease. However, the sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied.
Methods: A retrospective chart review was conducted in 388 consecutive TAVR patients (57.7% females, transfemoral approach in 59.3%, 77.9% with Sapien valve) without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB.
Results: LVH by echocardiographic criteria was present in all patients. Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 15% of patients; and in 53% of patients, neither criteria was suggestive for LVH. Only 37% of patients had LVH by Cornell Voltage and 25% by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001).
Older age was strongly associated with presence of LVH voltage criteria by both Sokolow-Lyon (OR=1.052, 95%CI 1.019-1.085, p=0.001) and Cornell criteria (OR=1.030, 95%CI 1.002-1.059, p=0.035). However, female gender was only predictive of LVH voltage criteria by Sokolow-Lyon (OR=2.844, 95%CI 1.672-4.837, p=0.001) and not by Cornell criteria (OR=1.160, 95%CI 0.663-2.030, p=0.603).
Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH in critical aortic stenosis patients undergoing TAVR. Sokolow-Lyon may predict LVH better in female patients, Therefore, ECG does not appear to be a suitable method of screening patients with severe aortic stenosis for LVH and the lack of LVH by voltage criteria does not imply non-critical aortic valve stenosis.