心电图应变模式在经导管主动脉瓣植入术后预后中的作用：DIRECT试验的亚组分析

The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial.

作者信息

Drakopoulou Maria, Oikonomou Georgios, Apostolos Anastasios, Karmpalioti Maria, Simopoulou Chryssa, Koliastasis Leonidas, Latsios George, Synetos Andreas, Benetos Georgios, Trantalis George, Sideris Skevos, Dilaveris Polychronis, Tsioufis Costas, Toutouzas Konstantinos

机构信息

First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.

State Department of Cardiology, Hippokration General Hospital, 11256 Athens, Greece.

出版信息

Life (Basel). 2023 May 24;13(6):1234. doi: 10.3390/life13061234.

DOI:10.3390/life13061234

PMID:37374017

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10305663/

Abstract

BACKGROUND

The presence of an electrocardiographic (ECG) strain pattern-among other ECG features-has been shown to be predictive of adverse cardiovascular outcomes in asymptomatic patients with aortic stenosis. However, data evaluating its impact on symptomatic patients undergoing TAVI are scarce. Therefore, we tried to investigate the prognostic impact of baseline ECG strain pattern on clinical outcomes after TAVI.

METHODS

A sub-group of patients of the randomized DIRECT (Pre-dilatation in Transcatheter Aortic Valve Implantation Trial) trial with severe aortic stenosis who underwent TAVI with a self-expanding valve in one single center were consecutively enrolled. Patients were categorized into two groups according to the presence of ECG strain. Left ventricular strain was defined as the presence of ≥1 mm convex ST-segment depression with asymmetrical T-wave inversion in leads V5 to V6 on the baseline 12-lead ECG. Patients were excluded if they had paced rhythm or left bundle branch block at baseline. Multivariate Cox proportional hazard regression models were generated to assess the impact on outcomes. The primary clinical endpoint was all-cause mortality at 1 year after TAVI.

RESULTS

Of the 119 patients screened, 5 patients were excluded due to left bundle branch block. Among the 114 included patients (mean age: 80.8 ± 7), 37 patients (32.5%) had strain pattern on pre-TAVI ECG, while 77 patients (67.5%) did not exhibit an ECG strain pattern. No differences in baseline characteristics were found between the two groups. At 1 year, seven patients reached the primary clinical endpoint, with patients in the strain group demonstrating significantly higher mortality in Kaplan-Meier plots compared to patients without left ventricular strain (five vs. two, log-rank = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square = 0.164). In the multivariate analysis, left ventricular strain was found to be an independent predictor of all-cause mortality after TAVI [Exp(B): 12.2, 95% Confidence Intervals (CI): 1.4-101.9].

CONCLUSION

Left ventricular ECG strain is an independent predictor of all-cause mortality after TAVI. Thus, baseline ECG characteristics may aid in risk-stratifying patients scheduled for TAVI.

摘要

背景

心电图（ECG）应变模式的存在——以及其他心电图特征——已被证明可预测无症状主动脉瓣狭窄患者的不良心血管结局。然而，评估其对接受经导管主动脉瓣置换术（TAVI）的有症状患者影响的数据却很少。因此，我们试图研究基线心电图应变模式对TAVI术后临床结局的预后影响。

方法

连续纳入在单一中心接受自膨式瓣膜TAVI的重度主动脉瓣狭窄患者，这些患者来自随机DIRECT（经导管主动脉瓣植入术中预扩张试验）试验的一个亚组。根据心电图应变情况将患者分为两组。左心室应变定义为在基线12导联心电图上，V5至V6导联出现≥1mm的凸面ST段压低并伴有不对称T波倒置。如果患者基线时存在起搏心律或左束支传导阻滞，则将其排除。生成多变量Cox比例风险回归模型以评估对结局的影响。主要临床终点是TAVI术后1年的全因死亡率。

结果

在119例筛查患者中，5例因左束支传导阻滞被排除。在114例纳入患者（平均年龄：80.8±7岁）中，37例（32.5%）在TAVI术前心电图上有应变模式，而77例（67.5%）未表现出心电图应变模式。两组间基线特征无差异。1年时，7例患者达到主要临床终点，在Kaplan-Meier曲线中，应变组患者的死亡率显著高于无左心室应变的患者（5例 vs. 2例，对数秩检验 = 0.022）。应变组和无应变组在预扩张操作方面无差异（21例 vs. 33例，卡方检验 = 0.164）。在多变量分析中，发现左心室应变是TAVI术后全因死亡率的独立预测因素[风险比（Exp(B)）：12.2，95%置信区间（CI）：1.4 - 101.9]。