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Pelliccia A, Tatangelo M, Borrazzo C, Zampaglione D, Mango F, Fedele E, Lanzillo C, Martino A, Crescenzi C, Maestrini V, Zorzi A, Corrado D, Calò L. Low QRS voltages and left ventricular hypertrophy: a risky association. Eur J Prev Cardiol 2023; 30:1132-1138. [PMID: 36779916 DOI: 10.1093/eurjpc/zwad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/14/2023]
Abstract
AIMS Low QRS voltages (LQRSV) are an unexpected finding in left ventricular hypertrophy, i.e. hypertrophic cardiomyopathy (HCM) or athlete's heart. METHODS AND RESULTS Prevalence and clinical correlates of LQRSV were investigated in 197 consecutive HCM patients, aged 58 ± 13 years and comparatively in 771 Olympic athletes, aged 23 ± 4. Clinical characterization included family/personal history, symptoms, New York Heart Association (NYHA) functional class, electrocardiographic pattern, ventricular arrhythmias, and cardiac magnetic resonance (CMR). Twenty-two (11%) of HCM and 18 (2.3%) of athletes presented LQRSV. At initial evaluation, in HCM, LQRSV showed no differences vs. non-LQRSV for functional class (90% vs. 91%, in Classes I and II; P = 0.983), symptoms (27% vs. 18%; P = 0.478), and ventricular arrhythmias (40% vs. 39%; P = 857) but showed larger extent of late gadolinium enhancement (LGE) at CMR (4.1 ± 1.5 vs. 1.5 ± 0.7 affected segments; P < 0.001). In athletes, LQRSV was associated with larger prevalence of inverted T-waves (22% vs. 9%; P < 0.001) and ventricular arrhythmias (28% vs. 8%; P = 0.005). In one LQRSV athlete, arrhythmogenic cardiomyopathy was identified. Over 4.5 ± 2.6-year follow-up, presence of LQRSV in HCM was associated with larger incidence of functional deterioration (31% vs. 14%; P = 0.038), stroke (22% vs. 6%; P = 0.008), and implantable cardioverter defibrillator (ICD) implant (27% vs. 10%; P = 0.015). No clinical events occurred in LQRSV athletes without initial evidence of cardiac disease. CONCLUSION LQRSV are relatively common (11%) in HCM and have clinical relevance, being predictive over a medium term for a worsening functional class, incidence of stroke, and ICD implant. Instead, LQRSV are rare (2.3%) in athletes but may occasionally be a marker that raises suspicion for underlying cardiac disease at risk.
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Affiliation(s)
- Antonio Pelliccia
- Department of Cardiology, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Mario Tatangelo
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
| | - Cristian Borrazzo
- Department of Public Health and Infectious Disease, University Sapienza, Piazzale Aldo Moro, 5, 00185 Roma, Italy
| | - Domenico Zampaglione
- Department of Cardiology, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Federica Mango
- Department of Cardiology, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Elisa Fedele
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
| | - Chiara Lanzillo
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
| | - Annamaria Martino
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
| | - Cinzia Crescenzi
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
| | - Viviana Maestrini
- Department of Cardiology, Institute of Sport Medicine and Science, Largo Piero Gabrielli 1, 00197 Rome, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Science and Public Health, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Science and Public Health, University of Padua, Via Giustiniani, 2 - 35128 Padova, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino Via Casilina 1049, 00169 Roma, Italy
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