Electrocardiographic (ECG) strain has been reported as a specific marker of midwall
left ventricular (LV) myocardial fibrosis, predictive of adverse clinical outcomes
in aortic stenosis (AS), but its prognostic impact after aortic valve replacement
(AVR) is unknown. We aimed to assess the impact of ECG strain on long-term mortality
after surgical AVR for AS. From January 2005 to January 2014, patients with interpretable
preoperative ECG who underwent isolated AVR for AS were included. ECG strain was defined
as ≥1-mm concave downslopping ST-segment depression with asymmetrical T-wave inversion
in lateral leads. Mortality was assessed over a follow-up period of 4.8 ± 2.7 years.
Among the 390 patients included, 110 had ECG strain (28%). They had significantly
lower body mass index, higher mean transaortic pressure gradient and Cornell-product
ECG LV hypertrophy than in those without ECG strain. There was also a trend for lower
LV ejection fraction in patients with ECG strain as compared with those without. Patients
with ECG strain had significantly lower 8-year survival than those without. ECG strain
remained associated with reduced survival both in patients with and without LV hypertrophy
(p <0.0001 for both). After adjustment, ECG strain remained a strong and independent
determinant of long-term survival (hazard ratio 4.4, p <0.0001). Similar results were
found in patients with LV hypertrophy or without LV hypertrophy. In the multivariate
model, the addition of ECG strain provided incremental prognostic value (p <0.0001).
In conclusion, in patients with AS, ECG strain is associated with 4-fold increased
risk of long-term mortality after isolated AVR, regardless of preoperative LV hypertrophy.
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Article Info
Publication History
Published online: July 25, 2017
Accepted:
June 30,
2017
Received:
April 19,
2017
Footnotes
Funding Sources: None.
See page 1364 for disclosure information.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
