Abstract
Objective: To evaluate changes in left ventricular (LV) electrocardiographic (ECG) voltage after surgical aortic valve replacement (SAVR) and to identify factors associated with ECG improvement. Methods: An observational before-after study of 81 patients undergoing SAVR, with ECG and echocardiographic assessment before and 6 months after surgery; LV overload was defined by the Sokolow-Lyon, Cornell Voltage and Peguero-Lo Presti criteria. Results: Mean age was 60.3 ± 10.5 years; 56.8% were male. Sokolow-Lyon, Cornell Voltage, and Peguero-Lo Presti decreased by 12.0, 7.0, and 7.0 mm, respectively (all p < 0.001). Composite ECG-LVH decreased from 84.0% to 46.9% (p < 0.001). LV strain pattern decreased from 50.6% to 37.0% (p = 0.013), significant only in aortic stenosis (absolute reduction 22.0%; p = 0.004). Left atrial overload decreased from 22.2% to 9.9% (p = 0.012). LVMI decreased from 151.4 ± 50.5 to 95.8 ± 29.7 g/m², LVEF increased from 58.0 ± 10.5% to 64.5 ± 7.2%, and LVEDd decreased from 51 to 40 mm (all p < 0.001). log2NT-proBNP was independently associated with ECG-LVH improvement (aOR 0.749; 95% CI 0.575-0.976; p = 0.032; AUC 0.746). Conclusion: ECG left ventricular voltage decreases substantially after SAVR, but only about 44% of patients with baseline ECG-LVH achieve ECG improvement at 6 months; higher preoperative NT-proBNP is associated with a lower likelihood of electrical recovery.
