Sinus of Valsalva Sclerosis is Associated with Conduction Abnormalities on 12-Lead Standard ECG

Background: Sclerosis of the sinus of valsalva correlates with cardiovascular disease burden. The anatomic proximity of the aortic root to the conduction system suggests potential association between sinus of valsalva sclerosis and conduction abnormalities. Methods: ECGs and clinical records from 108 consecutive patients undergoing transesophageal echocardiography for routine stroke work-up were collected from a single centre database. TEE standard loops and stand-ard 12 lead ECG recordings were analysed by 3 experienced cardiologists. Results: Of 129 patients, sclerosis of the sinus of valsalva was detected in 72 (55.8%), 39 (30.2%) had aortic valve sclerosis and 67 (51.9%) showed plaques of at least grade I in the ascending aorta. Conduction abnormalities and arrhythmias were found in 63 patients amongst others 30 with grade I, or higher AV-block, 10 patients with sinus node dysfunction, and 20 with atrial fibrillation. Sclerosis of the sinus of valsalva occurred in 42 of these 63 patients (p=0.022). Of 30 patients with AV-block grade I or higher, 26 presented a sinus valsalva sclerosis (p < 0.001), 7 of 10 patients with sinus node dysfunction presented a sinus valsalva sclerosis (p = 0.508) and 15 of 20 with atrial fibrillation (p = 0.081). Conclusion: Sclerosis of the sinus of valsalva is associated with atrioventricular conduction abnormalities.