DOI: 10.1161/circ.148.suppl_1.13731 ISSN: 0009-7322

Abstract 13731: Right-Sided Precordial U Waves as a Screening Tool for Aortic Stenosis

Matthew Pulaski, Aditi Newadkar, Iman Richie, Ivan Ho, Jubin Joseph, Ray Matthews, Anil Mehra, Junaid Zaman
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: AS affects 3% of individuals ≥ age 65 and portends an increased risk of morbidity and mortality. Cardiac auscultation to categorize AS severity depends on provider skill. Recent studies have identified an association between AS and right precordial U waves (RPUW) using machine learning. Therefore, the ECG may serve as an adjunctive screening tool for AS.

Hypothesis: Are RPUW correlated with AS severity?

Methods: A retrospective cohort analysis was performed of 50 patients ages 65-89 with a diagnosis of HTN, echocardiogram on file, and RPUW (V1-V3) in consecutive leads with U wave amplitude ≥ 0.5 mm in at least one lead. Patients with prior aortic valve replacement, ventricularly paced rhythms, AF or AFL, LBBB, potassium (K) < 3, and HR < 50 were excluded. A control cohort of 50 age- and gender- matched patients with RPUW < 0.5 mm was included. Echocardiograms were unblinded only once patients were selected by ECG criteria.

Results: In total, 976 charts and 294 charts were reviewed to identify 50 eligible patients for the experimental and control arms respectively. Median time between ECG and lab collection (to ensure a K ≥ 3) was 0 days for both arms. Median time between ECG and echocardiogram was 1 day and 1.5 days respectively for experimental and control arms. U waves were significantly correlated with AS severity using a chi-square test (X2 = 16.77, df = 3, p < .001). A multinomial logistic regression analysis showed no significant association between gender (p = .69) or systolic blood pressure (SBP) as a categorical variable (SBP < 125, 126-145, > 145) (p = .35) and AS severity, but increasing age group (ages 65-73, 74-81, or 82-89) was associated with greater odds of moderate or severe AS (p = .002), OR 3.43 (95% CI: 1.59, 7.40).

Conclusions: RPUW ≥ 0.5 mm demonstrate a significant correlation with AS severity. A prospective study which collects first-time echocardiograms for patients with RPUW serves as a next step in determining the utility of ECGs for screening of AS.

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