Key result
Baseline LV ECG strain predicts ~12-fold higher all-cause mortality at one year post-TAVI.
Why the study?
Data evaluating the impact of an ECG strain pattern on symptomatic patients undergoing TAVI were scarce.
Does the presence of baseline ECG strain pattern predict all-cause mortality in patients undergoing TAVI for severe aortic stenosis?
RCT (n=114)
No
Does the presence of baseline ECG strain pattern predict all-cause mortality in patients undergoing TAVI for severe aortic stenosis?
Effect estimate: HR 12.2 (95% CI 1.4-101.9)
Absolute Event Rate: 13.5% vs 2.6%
p-value: p=0.022
Baseline left ventricular ECG strain pattern is a strong independent predictor of 1-year all-cause mortality in patients undergoing TAVI.
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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Drakopoulou et al. (2023) conducted an RCT in severe aortic stenosis (n=114). Baseline ECG strain pattern vs. No ECG strain pattern was evaluated on all-cause mortality at 1 year after TAVI (HR 12.2, 95% CI 1.4-101.9, p=0.022). Baseline left ventricular ECG strain pattern was an independent predictor of 1-year all-cause mortality after TAVI compared to no strain (13.5% vs 2.6%; HR 12.2, 95% CI 1.4-101.9).
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