Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumicho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
J Cardiol. 2021 Apr;77(4):346-352. doi: 10.1016/j.jjcc.2020.12.017. Epub 2021 Jan 15.
Left ventricular hypertrophy (LVH) develops with both structural and electrical remodeling in response to elevated afterload due to aortic stenosis (AS). This study evaluated the prognostic value of electrocardiographic LVH (ECG LVH) after transcatheter aortic valve replacement (TAVR).
A retrospective study including 157 consecutive patients who underwent TAVR was conducted. ECG LVH was defined as Sokolow-Lyon voltage (S in V + R in V) before TAVR was ≥3.5mV. We investigated the association between ECG LVH and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. ECG and echocardiographic measurements at 1, 6, and 12 months after TAVR were assessed.
The baseline characteristics were comparable between the ECG LVH (n = 74) and non-ECG LVH groups (n = 83). The ECG LVH was associated with a significantly greater reduction of Sokolow-Lyon voltage and LV mass index than the non-ECG LVH after TAVR. The absence of ECG LVH was an independent predictor of the 1-year composite outcome [adjusted hazard ratio (HR), 2.27; 95% confidence interval (CI), 1.01 - 5.60; p = 0.04]. Furthermore, a reduction of Sokolow-Lyon voltage from baseline to 1-month follow-up, but not a reduction of LV mass index, was associated with a lower cumulative composite outcome from 1 month to 1 year (adjusted HR, 0.36; 95% CI, 0.15 - 0.86; p = 0.02).
ECG LVH was associated with a low incidence of adverse clinical outcomes and greater reverse LV remodeling after TAVR. Preprocedural and serial LVH assessment by ECG might be useful in AS patients undergoing TAVR.
由于主动脉瓣狭窄（AS）导致后负荷升高，左心室肥厚（LVH）会发生结构和电重构。本研究评估了经导管主动脉瓣置换术（TAVR）后心电图 LVH（ECG LVH）的预后价值。
对 157 例连续接受 TAVR 的患者进行回顾性研究。ECG LVH 定义为 TAVR 前 Sokolow-Lyon 电压（S 在 V + R 在 V）≥3.5mV。我们研究了 ECG LVH 与包括全因死亡和与心力衰竭相关再入院在内的 1 年复合结局之间的关系。评估 TAVR 后 1、6 和 12 个月的心电图和超声心动图测量值。
ECG LVH 组（n=74）和非 ECG LVH 组（n=83）的基线特征相当。与非 ECG LVH 组相比，TAVR 后 ECG LVH 组 Sokolow-Lyon 电压和 LV 质量指数明显降低。无 ECG LVH 是 1 年复合结局的独立预测因子[校正后的危险比（HR），2.27；95%置信区间（CI），1.01-5.60；p=0.04]。此外，与 1 个月至 1 年的累积复合结局较低相关的是从基线到 1 个月随访时 Sokolow-Lyon 电压的降低，而不是 LV 质量指数的降低（校正 HR，0.36；95%CI，0.15-0.86；p=0.02）。
ECG LVH 与 TAVR 后不良临床结局发生率低和 LV 逆向重构程度大相关。在接受 TAVR 的 AS 患者中，ECG 术前和连续 LVH 评估可能有用。
