Positive T wave in lead aVR is associated with left atrial and ventricular function and cardiac outcomes in heart failure patients with preserved ejection fraction

Murat B., MURAT S., Aydın F., DURAL M., Yalvac H. E., Durmaz F. E., ...Daha Fazla

Journal of Electrocardiology, cilt.90, 2025 (SCI-Expanded) identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 90
  • Basım Tarihi: 2025
  • Doi Numarası: 10.1016/j.jelectrocard.2025.153925
  • Dergi Adı: Journal of Electrocardiology
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL
  • Anahtar Kelimeler: Heart failure, Left atrial reservoir strain, Mortality, Positive TaVR
  • Eskişehir Osmangazi Üniversitesi Adresli: Evet

Özet

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for a significant proportion of heart failure cases and is associated with high morbidity and mortality. While echocardiography plays a central role in HFpEF assessment, the prognostic value of electrocardiographic (ECG) findings, particularly in lead aVR, remains underexplored. This study investigates the relationship between a positive T wave in lead aVR (TaVR) and left atrial (LA) and left ventricular (LV) function, as well as its prognostic significance in HFpEF patients. Methods: This retrospective study included 231 HFpEF patients diagnosed according to ESC guidelines. Patients underwent comprehensive echocardiography and 12‑lead ECG evaluation. Positive TaVR was defined as a T-wave amplitude ≥1 mm in lead aVR. LA and LV functions were assessed using LA reservoir strain (LASr) and LV global longitudinal strain (GLS), respectively. Multivariate Cox regression and Kaplan-Meier survival analyses were performed to evaluate the prognostic significance of TaVR. Results: Positive TaVR was observed in 34.6 % of patients and was associated with impaired LASr (15.02 ± 6.65 % vs. 17.78 ± 9.10 %, p = 0.023) and LV GLS (−13.66 ± 3.49 % vs. -15.19 ± 3.02 %, p = 0.001). Positive TaVR independently predicted 1-year all-cause mortality (HR = 6.02, p < 0.001) and 6-month all-cause mortality (HR = 9.67, p < 0.001). Patients with positive TaVR had higher hospitalization rates and worse clinical outcomes. Conclusion: Positive TaVR is associated with LA dysfunction, LV remodeling, and poor prognosis in HFpEF. Incorporating this ECG parameter into routine clinical assessments could enhance risk stratification and guide management strategies for HFpEF patients.