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

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....

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305663/
https://www.ncbi.nlm.nih.gov/pubmed/37374017
http://dx.doi.org/10.3390/life13061234
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author 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
author_facet 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
author_sort Drakopoulou, Maria
collection PubMed
description 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.
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spelling pubmed-103056632023-06-29 The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial 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 Life (Basel) Article 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. MDPI 2023-05-24 /pmc/articles/PMC10305663/ /pubmed/37374017 http://dx.doi.org/10.3390/life13061234 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
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
The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title_full The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title_fullStr The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title_full_unstemmed The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title_short The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial
title_sort role of ecg strain pattern in prognosis after tavi: a sub-analysis of the direct trial
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10305663/
https://www.ncbi.nlm.nih.gov/pubmed/37374017
http://dx.doi.org/10.3390/life13061234
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