Author + information
- Julien Magne,
- Barthelemy Guinot,
- Dania Mohty,
- Antoine Bourgeois,
- Alessandro Piccardo,
- Alexandre Le Guyader and
- Victor Aboyans
Background: Electrocardiographic (ECG) strain has been reported as a specific marker of midwall left ventricular (LV) myocardial fibrosis, predictive for adverse clinical outcomes in aortic stenosis (AS), but its prognostic impact following aortic valve replacement (AVR) is unknown. We aimed to assess the impact of ECG strain on postoperative mortality following surgical AVR for AS.
Methods: From 01/2005 to 01/2014, patients with interpretable preoperative ECG, without bundle-branch block or digoxin therapy, who underwent isolated AVR for AS were included. ECG strain was defined as ≥1-mm concave down-slopping ST-segment depression with symmetrical T-wave inversion in lateral leads. Mortality was assessed over a follow-up period of 4.8±2.7 years.
Results: Among the 390 patients included, 110 had ECG strain (28%). They had significantly lower body mass index (28±5 vs 26±5kg/m2, p=0.006), higher mean trans-aortic pressure gradient (54±17 vs. 49±14mmHg, p=0.005) and Cornell-product ECG LV hypertrophy (LVH, 45% vs. 22%, p<0.0001) than in those without ECG strain. There was also a trend for lower LV ejection fraction in patients with ECG strain as compared to those without (64±12 vs. 67±11%, p=0.068). The ECG strain group had significantly lower 8-year survival than those without ECG strain (40±6% vs. 81±3%, p<0.0001). ECG strain remained associated with reduced survival both in patients with LVH (n=111, p<0.0001) and those without LVH (n=278, p<0.0001). After adjustment for all relevant cofactors, ECG strain remained an independent determinant of long-term survival (HR=4, 95%CI: 2.6-6.3, p<0.0001). Similar results were found in patients with LVH (HR=5.6, 95%CI: 1.9-16.8, p=0.002) or without LVH (HR=3.9, 95%CI: 2.4-6.5, p<0.0001). In the multivariate model, the addition of ECG strain provided incremental prognostic value (full initial model: X2=29.9, model+ECG strain: X2=45.2; p<0.0001).
Conclusions: In patients with AS, ECG strain is associated with 4-fold increased risk of long term mortality following isolated AVR, regardless of preoperative LVH. This parameter should be systematically assessed in patients with AS in order to stratify the risk of these patients.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 10:45 a.m.-10:55 a.m.
Session Title: Novel Determinants of Outcomes in VHD
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1132M-09
- 2017 American College of Cardiology Foundation