Abstract 3001: Regression of the Electrocardiographic Strain Pattern Between Baseline and One Year of Antihypertensive Treatment is Strongly Associated With Regression of Electrocardiographic Left Ventricular Hypertrophy: The LIFE Study
Background: Presence of the ECG strain pattern of lateral ST depression and T-wave inversion is a marker of left ventricular hypertrophy (LVH) and adverse prognosis. However, whether regression of ECG strain during antihypertensive therapy is associated with regression of ECG LVH 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 a downsloping convex ST segment with an inverted asymmetrical T-wave opposite to the QRS axis in leads V5 and/or V6. ECG LVH was defined using Cornell voltage-duration product (CP) and Sokolow-Lyon voltage (SLV) criteria.
Results: Compared with the other groups, patients with regression of strain between baseline and year-1 had the greatest reductions in both CP and SLV, despite similar changes in systolic and diastolic pressure (Table⇓). In univariate logistic regression analyses, a 1-SD of the mean 1-year decrease in CP (−530 mm-ms) was associated with a 54% increased likelihood of regression of strain (95% CI 36–75%), a 1-SD decrease in SLV (−5.8 mm) with a 75% increased likelihood (95% CI 54–98%) and a 1-SD decrease in both with a 122% greater likelihood of regression of strain (95% CI 71–288%). After controlling for age, sex, treatment group, baseline severity of ECG LVH by CP and SLV, baseline and change in systolic and diastolic pressure and for other differences between groups, a 1-SD decrease in CP remained associated with a 22% increased odds of regression of strain (95% CI 5– 41%), a 1-SD decrease in SLV with a 41% increased odds (95% CI 22– 63%) and a 1-SD decrease in both CP and SLV with a 71% greater likelihood of regression of ECG strain (95% CI 48–98%).
Conclusions: Regression of ECG strain between baseline and year-1 is strongly associated with regression of ECG LVH, independent of baseline severity of LVH, baseline and change in blood pressure and other risk factors.