(CCSP043) CORRELATION OF ECG AND CARDIAC MRI FOR ASSESSMENT OF VENTRICULAR HYPERTROPHY/DILATATION IN ADULTS WITH CONGENITAL HEART DISEASE

Background: The electrocardiogram (ECG) is universally utilised to assess chamber hypertrophy and dilatation, including in adults with congenital heart disease (ACHD). Complex ACHD patients (Tetralogy of Fallot, Transposition of the great arteries and single ventricle physiology) have a higher incidence of right and left bundle branch block patterns (RBBB/LBBB) on ECG and many have right ventricular hypertrophy/dilatation (RVH/RVD) or left ventricular hypertrophy/dilatation (LVH/LVD).

Our objective was to determine the sensitivity/specificity of currently established ECG criteria in detecting RVH/RVD or LVH/LVD on cardiac MRI (cMRI) in the ACHD population.

METHODS AND RESULTS: We included consecutive patients from our ACHD clinic who had a cMRI performed between January 2012 and December 2019. ACHD patients with reported LVH, LVD, RVH or RVD on MRI were identified. The ECG to each corresponding cMRI was then used to determine RVH/LVH for sensitivity and specificity analysis. We used the Sokolow-Lyon and Cornell voltage criteria for diagnosis of LVH and the Sokolow-Lyon and Myers’ voltage criteria for diagnosis of RVH. The analysis of RVH was further extended for patients with or without right bundle branch block (RBBB).

Our study included 353 patients (mean age 41 ± 15 years, 40% female) with 298 patients with RVH/RVD confirmed on cMRI and 88 patients with MRI proven LVH or LVD. 38 patients had an ECG diagnosis of RVH, and 14 patients had LVH on ECG. 190 patients had a diagnosis of RBBB and one had a diagnosis of LBBB. For ECG reported diagnosis, the specificity for LVH was 98.18% (95% C.I. (90.28, 99.95)), and the sensitivity was 12.42% (95% C.I. (8.89, 16.71)). The positive predictive value (PPV) of LVH was 78.57% (95% C.I. (51.14, 92.78)), and the negative predictive value (NPV) was 77.29% (95% C.I. (75.85, 78.66)). When RBBB was absent, the ECG specificity for RVH was 100% (95% C.I. (92.29, 100.00)), and the sensitivity was 18.80% (95% C.I. (12.18, 27.07)). In subjects with RBBB, the specificity for RVH was 88.89% (95% C.I. (51.75, 99.72)), and the sensitivity was 1.19% (95% C.I. (0.14, 4.23)).

Conclusion:

Conclusion: The standard ECG voltage criteria have poor sensitivity for detecting right and left ventricular chamber hypertrophy and dilatation in ACHD patients. The presence of RBBB further reduces the sensitivity to detect RVH/RVD. New ECG voltage criteria should be established and adopted to accurately diagnose RVH/RVD and LVH/LVD in ACHD patients.