Abstract 12578: Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study
Background: The impact of electrocardiographic left ventricular (LV) strain and hypertrophy (LVH) on cardiovascular morbidity and mortality in asymptomatic aortic stenosis (AS) has not been well described.
Methods: Clinical-, electro- and echocardiographic examinations were performed in 1,873 asymptomatic patients with mild to moderate AS randomized to simvastatin/ezetimibe combination vs. placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Predictive value of electrocardiographic LV strain (defined as T-wave inversion in leads V4-6) and LVH (assessed by the Sokolow-Lyon voltage criterion (RV5-6+SV1 ≥35 mV) and Cornell voltage-duration criteria ((RaVL+SV3+[6 mV in women]) × QRS-duration ≥2440 mV·msec)), was evaluated in models adjusting for randomized treatment and other important prognostic covariates.
Results: A total of 1,533 patients were followed for 4.3±0.8 years (6,628 patient-years of follow-up). At baseline, electrocardiographic strain was present in 340 (23.6%) patients; LVH was detected by Sokolow-Lyon voltage in 260 (17.1%) and in 221 (14.6%) by Cornell voltage-duration product. In multivariable analyses, baseline electrocardiographic LV strain was associated with a 3.1-fold higher risk of myocardial infarction (95% confidence interval [CI], 1.4 to 6.8, p=0.004); LVH by Sokolow Lyon-voltage criterion with a 4.0 -fold higher risk of heart failure (CI, 1.8 to 9.3, p=0.001). Finally, presence of electrocardiographic LV strain or LVH by either electrocardiographic criterion was independently predictive of increased risk of AVR.
Conclusions: Electrocardiographic LV strain and LVH were, independent of echocardiographic and clinical covariates, predictive of poor prognosis during watchful waiting in asymptomatic AS.
- © 2011 by American Heart Association, Inc.