QRS integral: an electrocardiographic indicator of mechanical interventricular asynchrony

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• 作者：Alex ; er Samol ; Stefan Klotz ; Jö ; rg Stypmann ; Hans-Jü ; rgen Bruns ; Richard Houben ; Matthias Paul ; Christian Vahlhaus
• 关键词：Heart failure ; Interventricular asynchrony ; Cardiac resynchronization therapy ; Body surface mapping ; ECG
• 刊名：Journal of Electrocardiology
• 出版年：2010
• 出版时间：May-June 2010
• 年：2010
• 卷：43
• 期：3
• 页码：242-250
• 全文大小：1425 K

文摘

Aim

The aim of this study was to investigate whether interventricular asynchrony (IVA) can be measured by electrocardiography.

Methods

Sixty-two patients (New York Heart Association heart failure functional class III: age, mean ± SD: 64 ± 9 years; ejection fraction, mean ± SD: 24 % ± 8 % ; dilative cardiomyopathy/ischemic cardiomyopathy, n = 39/23) with left bundle branch block (QRS duration, mean ± SD: 165 ± 21 milliseconds) underwent a 120-channel body surface mapping. QRS integral was analyzed and compared with IVA (echo).

Results

Interventricular asynchrony was associated with significantly decreased QRS integrals 15 cm cranial and 6 cm lateral from V1 in patients with normal axis (n = 36): At a cutoff value of −26 milliseconds mV, receiver operating characteristic analysis to predict IVA revealed a sensitivity of 89 % and a specificity of 83 % (area under curve, mean ± SEM: 0.9 ± 0.07; P < .001). In patients with left axis deviation (n = 26), IVA showed significantly decreased QRS integrals 10 cm caudal from V1: at a cutoff value of −89 milliseconds mV, receiver operating characteristic analysis to predict IVA revealed a sensitivity of 83 % and a specificity of 100 % (area under curve, mean ± SEM: 0.9 ± 0.07; P < .002).

Conclusions

Interventricular asynchrony strongly correlates with QRS integral. Key lead positions, however, are axis dependent and outside standard leads.