Clinical InvestigationCongestive Heart FailureLow voltage on the electrocardiogram is a marker of disease severity and a risk factor for adverse outcomes in patients with heart failure due to systolic dysfunction
Section snippets
Patient populations
This is a retrospective study. From a consecutive series of patients (N = 551) evaluated in the Parkland Memorial Hospital CHF clinic7, 8 (“clinic cohort”) between June 1998 and June 2002, we included all patients (n = 415) who had a qualitatively reduced left ventricular ejection at the time of clinic referral and had an ECG within 6 months of their initial clinic visit. Patients with a paced rhythm (n = 11) were excluded.
A second cohort was gathered from the UT Southwestern cardiac transplant
Distribution and correlation of ECG voltages
Total ECG voltages in the clinic cohort ranged from 4.6 to 45 mV with a median (25th, 75th percentiles) of 15 (12, 20) mV. In the pretransplant cohort, ECG voltages ranged from 3.4 to 27 mV with a median (25th, 75th percentiles) of 12 (9.5, 16) mV. In the clinic cohort, there were significant correlations between total ECG voltage and total limb voltage (r = 0.76), total ECG voltage and total precordial voltage (r = 0.93), and total limb and total precordial voltages (r = 0.48) (P < .001 for
Discussion
We propose new criteria for defining low ECG voltage (∑QRS <12 mV) in patients with HF due to systolic dysfunction. Using these criteria in a contemporary cohort of HF patients, low voltage was a marker of disease severity, being more common in NYHA class 4 than class 1-3 patients. The prevalence of low voltage was further increased in patients with advanced HF as defined by referral for cardiac transplantation. Further, low ECG voltage was associated with an increased risk of adverse outcomes
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Volume-Weighted Unipolar Voltage: A Novel Prognostic Marker in Dilated Cardiomyopathy and Ventricular Arrhythmia
2023, JACC: Clinical ElectrophysiologyPrognostic Value of Electrocardiographic QRS Diminution in Patients Hospitalized With COVID-19 or Influenza
2021, American Journal of CardiologyCitation Excerpt :Low QRS complex amplitude on the ECG has been described in conditions that decrease net myocardial action potential generation or attenuate recorded surface voltage.10–18 In a variety of disease processes, low ECG voltage portends adverse outcomes.12,13,19,20 A recent multicenter analysis noted low QRS voltage in only 5% of COVID-19 patients, highlighting the potential importance of dynamic QRS amplitude diminution during the course of illness.
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2016, Journal of the American College of CardiologyRisk of mortality in individuals with low QRS voltage and free of cardiovascular disease
2014, American Journal of CardiologyCitation Excerpt :This is the first study that examines LQRSV in an asymptomatic population as a prognostic indicator of all-cause mortality. LQRSV may be present in certain conditions, such as obesity, anasarca, cardiac tamponade, hypothyroidism, and myocarditis.6–19 Because we excluded participants with history of CVD as well as adjusting for several CVD risk factors and pulmonary pathologies, the presence of LQRSV in otherwise healthy individuals may indicate undiagnosed subclinical disease in such individuals.
ECG alteration due to prolong exposure to natural gas leakage containing sulfur compounds in polluted areas of Masjid-I-Sulaiman (south of Iran)
2009, Ecotoxicology and Environmental SafetyElectrocardiogram voltage discordance: interpretation of low QRS voltage only in the limb leads
2008, Journal of ElectrocardiologyCitation Excerpt :Other potential or rare causes of low voltage, such as multiple or massive previous myocardial infarctions, thyroid disease, and normal variation have also been described.19,24,25 Although low voltage is defined as peak-to-peak QRS voltage less than 5 mm in all limb leads and less than 10 mm in all precordial leads,1,2 frequently, only the limb leads are used to determine low voltage in the literature,3,18,19 and the meaning of low limb lead voltage is unclear in clinical practice. This study found that low QRS voltage isolated to the limb leads is associated with significant pericardial disease, infiltrative cardiomyopathy, obesity, or emphysema in only half of patients.