Guinot Barthélémy, Magne Julien, Le Guyader Alexandre, Bégot Emmanuelle, Bourgeois Antoine, Piccardo Alessandro, Marsaud Jean-Philippe, Mohty Dania, Aboyans Victor
Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France.
Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France; Faculté de médecine de Limoges, INSERM 1094, Limoges, France.
Am J Cardiol. 2017 Oct 15;120(8):1359-1365. doi: 10.1016/j.amjcard.2017.06.072. Epub 2017 Jul 25.
Electrocardiographic (ECG) strain has been reported as a specific marker of midwall left ventricular (LV) myocardial fibrosis, predictive of adverse clinical outcomes in aortic stenosis (AS), but its prognostic impact after aortic valve replacement (AVR) is unknown. We aimed to assess the impact of ECG strain on long-term mortality after surgical AVR for AS. From January 2005 to January 2014, patients with interpretable preoperative ECG who underwent isolated AVR for AS were included. ECG strain was defined as ≥1-mm concave downslopping ST-segment depression with asymmetrical T-wave inversion in lateral leads. Mortality was assessed over a follow-up period of 4.8 ± 2.7 years. Among the 390 patients included, 110 had ECG strain (28%). They had significantly lower body mass index, higher mean transaortic pressure gradient and Cornell-product ECG LV hypertrophy than in those without ECG strain. There was also a trend for lower LV ejection fraction in patients with ECG strain as compared with those without. Patients with ECG strain had significantly lower 8-year survival than those without. ECG strain remained associated with reduced survival both in patients with and without LV hypertrophy (p <0.0001 for both). After adjustment, ECG strain remained a strong and independent determinant of long-term survival (hazard ratio 4.4, p <0.0001). Similar results were found in patients with LV hypertrophy or without LV hypertrophy. In the multivariate model, the addition of ECG strain provided incremental prognostic value (p <0.0001). In conclusion, in patients with AS, ECG strain is associated with 4-fold increased risk of long-term mortality after isolated AVR, regardless of preoperative LV hypertrophy.
心电图（ECG）应变已被报道为左心室（LV）中层心肌纤维化的特异性标志物，可预测主动脉瓣狭窄（AS）的不良临床结局，但其在主动脉瓣置换术（AVR）后的预后影响尚不清楚。我们旨在评估ECG应变对AS外科AVR术后长期死亡率的影响。纳入2005年1月至2014年1月期间因AS接受单纯AVR且术前心电图可解读的患者。ECG应变定义为外侧导联出现≥1mm的凹面下斜型ST段压低伴不对称T波倒置。在4.8±2.7年的随访期内评估死亡率。在纳入的390例患者中，110例有ECG应变（28%）。与无ECG应变的患者相比，他们的体重指数显著更低，平均跨主动脉压力梯度更高，Cornell乘积ECG左心室肥厚更明显。与无ECG应变的患者相比，有ECG应变的患者左心室射血分数也有降低趋势。有ECG应变的患者8年生存率显著低于无应变的患者。无论有无左心室肥厚，ECG应变均与生存率降低相关（两者p均<0.0001）。调整后，ECG应变仍然是长期生存的强有力独立决定因素（风险比4.4，p<0.0001）。在有或无左心室肥厚的患者中均发现了类似结果。在多变量模型中增加ECG应变可提供额外的预后价值（p<0.0001）。总之，在AS患者中，无论术前有无左心室肥厚，ECG应变与单纯AVR术后长期死亡风险增加4倍相关。
