Usefulness of Electrocardiographic Strain to Predict Survival After Surgical Aortic Valve Replacement for Aortic Stenosis
Section snippets
Methods
From January 2005 to January 2014, 575 consecutive patients with severe AS underwent isolated SAVR (i.e., without concomitant other valve intervention or coronary artery bypass graft) in our institution. Severe AS was defined as aortic valve area ≤1 cm2 or indexed aortic valve area ≤0.6 cm2/m2 and/or mean transaortic pressure gradient >40 mmHg. All patients with other concomitant significant valve disease (i.e., ≥grade 2 mitral regurgitation, or ≥grade 2 aortic regurgitation, or any mitral
Results
Among the 575 patients who underwent SAVR, included during the period, 390 were selected for the present study (Figure 2), among whom 110 (28%) had ECG strain. The baseline preoperative characteristics of the population are reported in Table 1. Only 11% of patients had reduced (i.e., <50%) LV ejection fraction.
The comparison between patients with ECG strain and those without ECG strain is reported in Table 1. Patients with ECG strain had significantly larger body mass index, higher creatinine
Discussion
The main findings of this study are that in patients with severe AS requiring SAVR, ECG strain (1) is frequent (28%), even in absence of LV hypertrophy (22%); (2) is associated with more severe AS advanced New York Heart Association functional class and low body mass index; and (3) is an independent marker of markedly reduced long-term survival rate, regardless of concomitant LV hypertrophy.
ECG strain is a well-known and validated electrical LV hypertrophy parameter6, 7, 8, 9 associated with
Disclosure
The authors have no conflicts of interest to disclose.
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Cited by (9)
Electrocardiographic left ventricular strain pattern, ST-segment depression and atrial fibrillation at the time of diagnosis of systemic light chain amyloidosis: Incidence and clinical significance
2021, Journal of ElectrocardiologyCitation Excerpt :Myocardial interstitial fibrosis was also observed to be more outspread in patients with ECG strain in comparison to those without [7]. In severe aortic stenosis ECG strain pattern may be present without anatomic LVH [27]. Among 30 ECGs with ST-segment depression high-rate (>100 beats per minute) rhythm was observed in 1 ECG, whereas all other ECGs with ST-segment depression showed normosystolic sinus rhythm or normosystolic AF.
The electrocardiogram: Still a useful marker for LV fibrosis in aortic stenosis
2021, Journal of ElectrocardiologyCitation Excerpt :LV strain is independent of LV mass or LVH [7,8,15,31] but is associated with LGE and diffuse interstitial fibrosis by T1 mapping [31], and abnormal GLS and integrated backscatter (IBS) as systolic deformation markers on 2D speckle-tracking echocardiography [32]. The prevalence of ECG strain is 14 to 19% [7,9,15,31] in unselected patients with AS and 21–39% in patients with severe AS [9,12,33]. The prevalence depends on age [12], peak aortic jet velocity [8] and symptoms, and is higher with a reduced LVEF [9,29] and in males [12].
Clinical significance of electrocardiographic markers of myocardial damage prior to aortic valve replacement
2020, International Journal of CardiologyCitation Excerpt :Moreover, in line with studies identifying GLS and IBS as tools to detect increased myocardial fibrosis [17,23], these 2 parameters exploring the LV were significantly depressed in AS patients with BBB or ECG strain pattern. In addition of being a marker of a more advanced disease, ECG strain was independently associated with poor outcomes, corroborating recent findings by Magne et al. [13]. Based on our findings, multiparametric stratification of patients with severe AS prior to AVR should integrate hallmarks of ventricular myocardial damage.
Prognostic Implication of Electrocardiographic Left Ventricular Strain in Patients Who Underwent Transcatheter Aortic Valve Implantation
2018, American Journal of CardiologyCitation Excerpt :To our knowledge, this is the first study to document a predicative utility for LV strain specifically in the TAVI population. In a similar study in patients with AS who underwent surgical aortic valve replacement, Guinot et al revealed that patients with ECG strain had 3.3- to 4.4-fold increase in mortality than those without ECG strain despite full adjustment for age, gender, EuroScore-II, and LV hypertrophy.2 In their study, ECG strain provided an incremental predictive value in subgroups of patients with or without LV-hypertrophy (HR 5.66, 95% CI [1.86 to 17.25], p = 0.002; HR 9.10, 95% CI [3.12 to 26.55], p <0.0001, respectively).
Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis
2023, Journal of Clinical Medicine
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