Zhang Robert, Jou Stephanie, Cao Yulei, Keller Kevin, Xiao Emily, de La Rosa Angelo, DeLago Augustin, El-Hajjar Mohammad, Torosoff Mikhail
Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
Department of Medicine, Columbia Presbyterian Medical Center, New York, NY, United States of America.
J Electrocardiol. 2020 Nov-Dec;63:12-16. doi: 10.1016/j.jelectrocard.2020.09.010. Epub 2020 Sep 30.
We examined the association between the absence ECG LVH and all-cause mortality in patients with severe AS undergoing TAVR.
We conducted a retrospective single center study on 399 TAVR patients from 2012 to 2016. ECGs were reviewed for LVH diagnosed by Sokolow-Lyon's voltage criteria. All patients met echocardiographic criteria for LVH. Logistic regression was used to examine the association between ECG LVH and covariates. Survival analysis was performed using Cox regression analysis and Kaplan Meier curves.
Patients without ECG LVH were younger (81.0 ± 8.4 vs. 84.0 ± 7.7 years, p = 0.001) with a higher BMI (29.3 ± 7.0 vs. 27.1 ± 5.6 kg/m, p = 0.006) and lower FEV1 (65.6 ± 22.8 vs. 74.1 ± 21.6%, p = 0.002). In multivariable analysis, increased BMI and decreased FEV1 remained predictive of the absence of ECG LVH. Over a mean follow-up time of 32 (± 17.0) months, the 5-year cumulative survival was 79% in the ECG LVH group and 58% in the group without ECG LVH (p = 0.039). Absence of ECG LVH remained predictive of all-cause mortality (HR 1.56, 95% CI 1.01-2.59, p = 0.045) in multivariable Cox regression analysis. When patients were grouped by comorbidities, patients with the highest mortality were those with increased BMI or decreased FEV1.
Absence of LVH by ECG criteria in patients with severe AS undergoing TAVR was associated with increased all-cause mortality. Routinely performed, noninvasive and inexpensive ECG may aid in identification of high-risk patients that may not benefit from TAVR and warrant further evaluation of underlying comorbidities.
我们研究了接受经导管主动脉瓣置换术（TAVR）的严重主动脉瓣狭窄（AS）患者中，心电图左心室肥厚（LVH）缺失与全因死亡率之间的关联。
我们对2012年至2016年期间的399例TAVR患者进行了一项回顾性单中心研究。根据Sokolow-Lyon电压标准对心电图进行复查以诊断LVH。所有患者均符合超声心动图LVH标准。采用逻辑回归分析来研究心电图LVH与协变量之间的关联。使用Cox回归分析和Kaplan-Meier曲线进行生存分析。
无心电图LVH的患者更年轻（81.0±8.4岁 vs. 84.0±7.7岁，p = 0.001），体重指数（BMI）更高（29.3±7.0 vs. 27.1±5.6 kg/m²，p = 0.006），第一秒用力呼气容积（FEV1）更低（65.6±22.8% vs. 74.1±21.6%，p = 0.002）。在多变量分析中，BMI升高和FEV1降低仍然是心电图LVH缺失的预测因素。在平均随访时间32（±17.0）个月期间，心电图LVH组的5年累积生存率为79%，无心电图LVH组为58%（p = 0.039）。在多变量Cox回归分析中，心电图LVH缺失仍然是全因死亡率的预测因素（风险比1.56，95%置信区间1.01 - 2.59，p = 0.045）。当按合并症对患者进行分组时，死亡率最高的患者是BMI升高或FEV1降低的患者。
接受TAVR的严重AS患者中，根据心电图标准无LVH与全因死亡率增加相关。常规进行的、无创且廉价的心电图检查可能有助于识别可能无法从TAVR中获益的高危患者，并需要对潜在合并症进行进一步评估。
