Rachel Bastiaenen1, Antonis Pantazis2, Hanney Gonna3, Irina Chis-Ster4, Silvia Castelletti5, Velislav N Batchvarov6, Giulia Domenichini7, Fabio Coccolo8, Giuseppe Boriani8, William J McKenna5, Elijah R Behr1, Mark M Gallagher9. 1. St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom. 2. The Heart Hospital, University College London Hospitals NHS Trust, London, United Kingdom. 3. St. George's University Hospitals NHS Foundation Trust, London, United Kingdom; Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom. 4. Institute of Infection and Immunity, St. George's University of London, United Kingdom. 5. National Heart and Lung Institute, Imperial College London, United Kingdom. 6. Institute of Cardiovascular and Cell Sciences, St. George's University of London, United Kingdom. 7. St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. 8. University of Bologna Institute of Cardiology, Bologna, Italy. 9. St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: mark_m_gallagher@hotmail.com.
Abstract
BACKGROUND: The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality. In arrhythmogenic right ventricular cardiomyopathy (ARVC), early diagnosis is difficult using current methods, and life-threatening arrhythmias are common and difficult to predict. OBJECTIVE: The purpose of this study was to assess the utility of ventricular ectopic indices including VEQSI in ARVC diagnosis. METHODS: We studied 70 patients with ARVC [30 with definite disease (age 47 ± 12 years; 60% male), 40 with incomplete disease expression (age 44 ± 18 years; 44% male)], 116 healthy controls (age 40 ± 15 years; 56% male), and 26 patients with normal heart right ventricular outflow tract (RVOT) ectopy (age 46 ± 17 years; 27% male). The duration of the broadest ventricular ectopic beat during 12-lead Holter monitoring was recorded as VEQSI max. RESULTS: VEQSI max was associated with age and gender, but not with conducted QRS duration. Adjusted VEQSI max was greater in ARVC patients than in control groups. In healthy males (44.5 years), estimated VEQSI max was 163 ms (95% confidence interval [CI] 159-167 ms); in definite ARVC 212 ms (95% CI 206-217 ms); in incompletely expressed ARVC 204 ms (95% CI 199-210 ms); and in normal heart RVOT ectopy 171 ms (95% CI 165-178 ms). VEQSI max >180 ms had 98% sensitivity and specificity for diagnosis of ARVC (area under the curve 0.99, 95% CI 0.980-0.998). In our incompletely expressed ARVC patients, VEQSI max >180 ms identified 88% as affected. CONCLUSION: VEQSI max distinguishes ARVC patients, including those with incomplete disease expression, from healthy controls and patients with normal heart RVOT ectopy.
BACKGROUND: The ventricular ectopic QRS interval (VEQSI) has been shown to identify structural heart disease and predict mortality. In arrhythmogenic right ventricular cardiomyopathy (ARVC), early diagnosis is difficult using current methods, and life-threatening arrhythmias are common and difficult to predict. OBJECTIVE: The purpose of this study was to assess the utility of ventricular ectopic indices including VEQSI in ARVC diagnosis. METHODS: We studied 70 patients with ARVC [30 with definite disease (age 47 ± 12 years; 60% male), 40 with incomplete disease expression (age 44 ± 18 years; 44% male)], 116 healthy controls (age 40 ± 15 years; 56% male), and 26 patients with normal heart right ventricular outflow tract (RVOT) ectopy (age 46 ± 17 years; 27% male). The duration of the broadest ventricular ectopic beat during 12-lead Holter monitoring was recorded as VEQSI max. RESULTS: VEQSI max was associated with age and gender, but not with conducted QRS duration. Adjusted VEQSI max was greater in ARVC patients than in control groups. In healthy males (44.5 years), estimated VEQSI max was 163 ms (95% confidence interval [CI] 159-167 ms); in definite ARVC 212 ms (95% CI 206-217 ms); in incompletely expressed ARVC 204 ms (95% CI 199-210 ms); and in normal heart RVOT ectopy 171 ms (95% CI 165-178 ms). VEQSI max >180 ms had 98% sensitivity and specificity for diagnosis of ARVC (area under the curve 0.99, 95% CI 0.980-0.998). In our incompletely expressed ARVC patients, VEQSI max >180 ms identified 88% as affected. CONCLUSION: VEQSI max distinguishes ARVC patients, including those with incomplete disease expression, from healthy controls and patients with normal heart RVOT ectopy.
Authors: Paramdeep S Dhillon; Giulia Domenichini; Hanney Gonna; Anthony Li; Nadia Sunni; Michael Mahmoudi; Mark M Gallagher Journal: J Med Case Rep Date: 2016-09-15