Coisne Augustin, Ninni Sandro, Pontana François, Aghezzaf Samy, Janvier Florent, Mouton Stéphanie, Ridon Hélène, Ortmans Staniel, Seunes Claire, Wautier Marine, Coppin Amandine, Madika Anne-Laure, Boutie Bertrand, Koussa Mohamad, Bical Antoine, Vincentelli André, Juthier Francis, Loobuyck Valentin, Sudre Arnaud, Marchetta Stella, Martinez Christophe, Staels Bart, Lancellotti Patrizio, Modine Thomas, Montaigne David
CHU Lille, Department of Clinical Physiology and Echocardiography, France; Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France.
Univ. Lille, U1011 - EGID, F-59000 Lille, France; Inserm, U1011, F-59000 Lille, France; Institut Pasteur de Lille, F-59000 Lille, France; CHU Lille, Department of Cardiovascular Medicine, France.
Int J Cardiol. 2020 May 15;307:130-135. doi: 10.1016/j.ijcard.2020.01.073. Epub 2020 Jan 29.
Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS).
Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke.
BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13-2.14, p = 0.006; HR 1.47, 95%CI 1.02-2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF.
Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR.
术前心肌纤维化和重塑会影响主动脉瓣置换术（AVR）后的结局。我们旨在研究术前左心室（LV）心肌损伤的心电图（ECG）标志物，即严重主动脉瓣狭窄（AS）患者（手术或经导管）AVR术后的束支传导阻滞（BBB）和ECG应变模式的预后影响。
2008年4月至2017年10月期间，我们对因严重AS首次接受AVR而转诊至我们心脏瓣膜诊所的连续患者进行了研究。进行了详细的术前表型分析和ECG分析。AVR术后对患者进行主要心脏事件（ME）随访，即心血管死亡、因急性心力衰竭住院和中风。
在纳入的1122例患者中，分别有13.5%和21%观察到BBB和ECG应变。与无ECG应变或BBB的患者相比，这些ECG标志物识别出一组年龄较大、纽约心脏协会（NYHA）分级较高且超声心动图检测到的心肌疾病更严重的患者亚组，即左心室质量更高、左心室射血分数、整体纵向应变和背向散射积分更低。在平均4.4±1.5年的随访期间，212例（18.6%）患者发生了ME，ECG应变或BBB患者的发生率更高（HR 1.56，95%CI 1.13-2.14，p = 0.006；HR 1.47，95%CI 1.02-2.13，p = 0.04）。在校正年龄、糖尿病和术前左心室射血分数后，ECG应变的预后价值仍然显著。
术前心肌损伤的ECG标志物可识别出一组AVR术后心血管并发症高危的AS患者亚组，无论其他预后因素如何，并且应有助于心脏损伤的多参数分期以指导AVR。
