在无症状主动脉瓣狭窄患者中，心电图左心室应变和肥厚的临床意义：辛伐他汀和依折麦布在主动脉瓣狭窄研究中的应用。
Clinical implications of electrocardiographic left ventricular strain and hypertrophy in asymptomatic patients with aortic stenosis: the Simvastatin and Ezetimibe in Aortic Stenosis study.
机构信息
Rigshospitalet, Department of Medicine B2142, The Heart Center, 9 Blegdamsvej, DK-2100, Copenhagen, Denmark.
出版信息
Circulation. 2012 Jan 17;125(2):346-53. doi: 10.1161/CIRCULATIONAHA.111.049759. Epub 2011 Dec 6.
BACKGROUND
The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described.
METHODS AND RESULTS
Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V(4) through V(6)) and LVH, assessed by Sokolow-Lyon voltage criteria (R(V5-6)+S(V1) ≥35 mV) and Cornell voltage-duration criteria {[RaVL+S(V3)+(6 mV in women)]×QRS duration ≥2440 mV · ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3±0.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4-6.8; P=0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0-16.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3-3.1; both P=0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3-4.9; P=0.008).
CONCLUSIONS
ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.
CLINICAL TRIAL REGISTRATION
http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
背景
心电图左心室应变和左心室肥厚（LVH）对无症状主动脉瓣狭窄的预后影响尚不清楚。
方法和结果
数据来自无症状患者随机分配至辛伐他汀/依折麦布联合治疗组或安慰剂组的 Simvastatin and Ezetimibe in Aortic Stenosis（SEAS）研究。主要终点为心肌梗死、非出血性卒、心力衰竭、主动脉瓣置换或心血管死亡的首次发生。心电图左心室应变（定义为 V（4）至 V（6）导联 T 波倒置）和 LVH 的预测价值，通过 Sokolow-Lyon 电压标准（R（V5-6）+S（V1）≥35 mV）和 Cornell 电压-持续时间标准{[RaVL+S（V3）+（6 mV 在女性中）]×QRS 持续时间≥2440 mV·ms}评估，通过调整其他预后协变量进行校正。共 1533 例患者接受了 4.3±0.8 年（6592 患者-年的随访），发生了 627 例心血管事件。340 例患者（23.6%）存在心电图应变，260 例患者（17.1%）符合 Sokolow-Lyon 电压标准的 LVH，220 例患者（14.6%）符合 Cornell 电压-持续时间乘积标准的 LVH。多变量分析显示，心电图左心室应变与研究期间心肌梗死的风险增加 3.1 倍相关（95%置信区间，1.4-6.8；P=0.004）。同样，两种标准的心电图 LVH 预测与无心电图 LVH 相比，心力衰竭的风险增加 5.8 倍（95%置信区间，2.0-16.8），主动脉瓣置换的风险增加 2.0 倍（95%置信区间，1.3-3.1；均 P=0.001），心肌梗死、心力衰竭或心血管死亡的复合终点风险增加 2.5 倍（95%置信区间，1.3-4.9；P=0.008）。
结论
心电图左心室应变和 LVH 可独立预测无症状主动脉瓣狭窄患者的不良预后。
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