Abstract 2757: Development of New Electrocardiographic Strain Pattern is Associated With an Increased Risk of Cardiovascular Morbidity and Mortality During Antihypertensive Treatment: The LIFE Study
Background: Presence of the ECG strain pattern of lateral ST depression and T-wave inversion at baseline has been associated with an increased risk of cardiovascular (CV) morbidity and mortality. However, the relationship of CV outcomes to regression vs persistence vs development of new ECG strain during antihypertensive therapy has not been examined.
Methods: ECG strain was evaluated at baseline and after one year of therapy in 7409 hypertensive patients in the LIFE Study who were treated with losartan- or atenolol-based regimens. Strain was defined by the presence of a downsloping convex ST segment with an inverted asymmetrical T-wave opposite to the QRS axis in leads V5 and/or V6. Events during mean follow-up of 3.8±0.8 years after the year-1 ECG were considered for analyses.
Results: The LIFE composite endpoint of CV death or nonfatal myocardial infarction (MI) or stroke occurred in 600 patients (8.1%), CV death in 236 (3.2%), MI in 198 (2.7%) and stroke in 313 patients (4.2%). Strain was absent on both baseline and year-1 ECGs in 6323 patients (85.3%), regressed from baseline to year-1 in 245 (3.3%), persisted on both ECGs in 549 (7.4%) and was absent at baseline but developed by year-1 in 292 patients (3.9%). Compared with absence of strain on both ECGs, development of new ECG strain was associated with higher 5-year event rates; patients with regression or persistence of strain had intermediate event rates (Table⇓). In Cox analyses adjusting for in-treatment ECG left ventricular hypertrophy (LVH) by Cornell product and Sokolow-Lyon voltage, in-treatment systolic and diastolic pressure, treatment effect and standard CV risk factors, development of new ECG strain was associated with an increased risk of all endpoints while the risk associated with regression or persistence of strain was attenuated.
Conclusions: Development of new ECG strain is associated with a increased risk of CV morbidity and mortality in the setting of antihypertensive therapy and regression of ECG LVH.