Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy

Abstract Introduction Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations. Methods In this prospective cohort study of 169 MD patients and 34 ne...

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Autores principales:	Anish Nikhanj, Haran Yogasundaram, Shane Kimber, Zaeem A. Siddiqi, Gavin Y. Oudit
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	electrocardiogram left bundle branch block left ventricular hypertrophy muscular dystrophy QRS fragmentation Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/7dfd824018f44e0d826d47bf169a7f4e
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spelling	oai:doaj.org-article:7dfd824018f44e0d826d47bf169a7f4e2021-11-12T11:40:14ZClinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy1542-474X1082-720X10.1111/anec.12876https://doaj.org/article/7dfd824018f44e0d826d47bf169a7f4e2021-11-01T00:00:00Zhttps://doi.org/10.1111/anec.12876https://doaj.org/toc/1082-720Xhttps://doaj.org/toc/1542-474XAbstract Introduction Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations. Methods In this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12‐lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram‐indicated left ventricular hypertrophy (ECG‐LVH) as well as ECG morphologies. Results Cornell voltage, Cornell voltage‐duration, Sokolow–Lyon voltage, and Romhilt‐Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG‐LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD. Conclusion The identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG‐LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.Anish NikhanjHaran YogasundaramShane KimberZaeem A. SiddiqiGavin Y. OuditWileyarticleelectrocardiogramleft bundle branch blockleft ventricular hypertrophymuscular dystrophyQRS fragmentationDiseases of the circulatory (Cardiovascular) systemRC666-701ENAnnals of Noninvasive Electrocardiology, Vol 26, Iss 6, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	electrocardiogram left bundle branch block left ventricular hypertrophy muscular dystrophy QRS fragmentation Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	electrocardiogram left bundle branch block left ventricular hypertrophy muscular dystrophy QRS fragmentation Diseases of the circulatory (Cardiovascular) system RC666-701 Anish Nikhanj Haran Yogasundaram Shane Kimber Zaeem A. Siddiqi Gavin Y. Oudit Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
description	Abstract Introduction Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations. Methods In this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12‐lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram‐indicated left ventricular hypertrophy (ECG‐LVH) as well as ECG morphologies. Results Cornell voltage, Cornell voltage‐duration, Sokolow–Lyon voltage, and Romhilt‐Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG‐LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD. Conclusion The identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG‐LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.
format	article
author	Anish Nikhanj Haran Yogasundaram Shane Kimber Zaeem A. Siddiqi Gavin Y. Oudit
author_facet	Anish Nikhanj Haran Yogasundaram Shane Kimber Zaeem A. Siddiqi Gavin Y. Oudit
author_sort	Anish Nikhanj
title	Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
title_short	Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
title_full	Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
title_fullStr	Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
title_full_unstemmed	Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
title_sort	clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/7dfd824018f44e0d826d47bf169a7f4e
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Clinical utility of 12‐lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy

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