Unit:
Κατεύθυνση Επεμβατική ΚαρδιολογίαLibrary of the School of Health Sciences
Author:
Vlachakis Panayotis
Supervisors info:
Τούτουζας Κωνσταντίνος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κυρίτση Ελένη, Ομότιμος Καθηγήτρια, Τμήμα Νοσηλευτικής, ΠΑΔΑ
Τούσουλης Δημήτριος, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Ο προγνωστικός ρόλος του ηλεκτροκαρδιογραφικού ευρήματος της κατιούσας πτώσης του ST-διαστήματος με ταυτόχρονη αναστροφή του Τ κύματος (strain) σε ασθενείς που έχουν υποβληθεί σε διαδερμική αντικατάσταση της αορτικής βαλβίδας
Translated title:
The role of ECG strain pattern in prognosis after TAVI: a sub-analysis of the DIRECT trial
Summary:
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 p = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square p = 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.
Main subject category:
Health Sciences
Keywords:
Electrocardiographic strain pattern, Transcatheter aortic valve implantation, Self-expanding valve
