Vectorcardiography signs of a failing Fontan: Heart rate, PR interval, RtQRSvm, QRSvm and SPQRS-T angle as noninvasive markers of late Fontan complications and mortality.

Congenital heart disease (CHD) Electrocardiography (ECG) Fontan failure (FF) Fontan survival (FS) Hypoplastic left heart syndrome (HLHS) Left ventricle (LV) Vectorcardiography (VCG)

Journal

Journal of electrocardiology

ISSN: 1532-8430

Titre abrégé: J Electrocardiol

Pays: United States

ID NLM: 0153605

Informations de publication

Date de publication:
07 May 2024

Historique:

received: 21 02 2024

revised: 13 04 2024

accepted: 25 04 2024

medline: 15 6 2024

pubmed: 15 6 2024

entrez: 14 6 2024

Statut: aheadofprint

Résumé

Limited data exists on interpreting vectorcardiography (VCG) parameters in the Fontan population. The purpose of this study was to demonstrate the associations between ECG/VCG parameters and Fontan failure (FF). 107 patients with a Fontan operation after 1990 and without significant ventricular pacing were included. FF and Fontan survival (FS) groups were compared. The average follow-up after Fontan operation was 11.8 years ±7.1 years. 14 patients had FF (13.1%) which was defined as having protein-losing-enteropathy (1.9%), plastic bronchitis (2.8%), Fontan takedown (1.9%), heart transplant (5.6%), NYHA class III-IV (2.8%) or death (0.9%). A 12‑lead ECG at last follow up or prior to FF was assessed for heart rate, PR interval, QRS duration, Qtc and left/right sided precordial measures (P-wave, QRS and T-wave vector magnitudes, spatial P-R and QRS-T angles). Transthoracic echocardiogram evaluated atrioventricular valve regurgitation and ventricular dysfunction at FF or last follow up. A cox multivariate regression analysis adjusted for LV dominance, ventricular dysfunction, HR, PR, QTc, Pvm, QRSvm, SPQRST-angle, RtPvm, RtQRSvm and RtTvm. Ventricular dysfunction, increased heart rate and prolonged PR interval were significantly associated to FF at the multivariate analysis. ROC analysis and Kaplan-meier analysis revealed an increased total mortality associated with a heart rate > 93 bpm, PR interval > 155 mv, QRSvm >1.91 mV, RtQRSvm >1.8 mV and SPQRST angle >92.3 mV with p values <0.001 to 0.018. We demonstrate the importance of ECG/VCG monitoring in the Fontan population and suggest specific indicators of late complications and mortality.

Sections du résumé

BACKGROUND BACKGROUND

Limited data exists on interpreting vectorcardiography (VCG) parameters in the Fontan population.

OBJECTIVE OBJECTIVE

The purpose of this study was to demonstrate the associations between ECG/VCG parameters and Fontan failure (FF).

METHODS/RESULTS RESULTS

107 patients with a Fontan operation after 1990 and without significant ventricular pacing were included. FF and Fontan survival (FS) groups were compared. The average follow-up after Fontan operation was 11.8 years ±7.1 years. 14 patients had FF (13.1%) which was defined as having protein-losing-enteropathy (1.9%), plastic bronchitis (2.8%), Fontan takedown (1.9%), heart transplant (5.6%), NYHA class III-IV (2.8%) or death (0.9%). A 12‑lead ECG at last follow up or prior to FF was assessed for heart rate, PR interval, QRS duration, Qtc and left/right sided precordial measures (P-wave, QRS and T-wave vector magnitudes, spatial P-R and QRS-T angles). Transthoracic echocardiogram evaluated atrioventricular valve regurgitation and ventricular dysfunction at FF or last follow up. A cox multivariate regression analysis adjusted for LV dominance, ventricular dysfunction, HR, PR, QTc, Pvm, QRSvm, SPQRST-angle, RtPvm, RtQRSvm and RtTvm. Ventricular dysfunction, increased heart rate and prolonged PR interval were significantly associated to FF at the multivariate analysis. ROC analysis and Kaplan-meier analysis revealed an increased total mortality associated with a heart rate > 93 bpm, PR interval > 155 mv, QRSvm >1.91 mV, RtQRSvm >1.8 mV and SPQRST angle >92.3 mV with p values <0.001 to 0.018.

CONCLUSION CONCLUSIONS

We demonstrate the importance of ECG/VCG monitoring in the Fontan population and suggest specific indicators of late complications and mortality.

Identifiants

DOI: 10.1016/j.jelectrocard.2024.04.008 PMID: 38876821

pubmed: 38876821

pii: S0022-0736(24)00059-1

doi: 10.1016/j.jelectrocard.2024.04.008

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of competing interest Authors have no conflicts of interest to disclose.