Background and Hypothesis: Left Ventricular Hypertrophy (LVH) due to critical aortic stenosis is expected in TAVR patients. ECG markers of LVH were associated with a significant increase in all-cause mortality in a large prospective study (ARIC) of the general, middle-aged population. However, the sensitivity of LVH by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. The regression of LVH by ECG voltage criteria after TAVR also has not been evaluated.
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: Pre-TAVR LVH by echocardiographic criteria was present in all patients. Sokolow-Lyon and Cornell criteria for LVH were present and concordant in 15% of patients; and in 53% of patients, neither ECG criteria was suggestive for LVH. Concordance between these two citeria was poor, with 37% of patients had LVH only by Cornell and 25% only by Sokolow-Lyon criteria (p<0.0001). One hundred forty one of 388 patients had follow up ECG’s at least 6 months (9.0+/-12.8 months) post-TAVR, with 13% no longer indicating LVH by Sokolow-Lyon criteria (p=0.005). Post-TAVR LVH by SL criteria was more likely in women (83 vs. 17%, p=0.015). Other co-morbidities and demographic variables were not predictive of LVH regression by ECG criteria.
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. Despite significant variability in pre-TAVR LVH manifestation by traditional ECG criteria, LVH regression by ECG criteria may be observed fairly soon after TAVR. Additional research is needed to clarify clinical implications and long-term outcomes associated with post-TAVR LVH regression.