Key result
The presence of an ECG strain pattern was an independent predictor of increased left ventricular mass index (OR 7.10) and was associated with more diffuse myocardial fibrosis in patients with severe aortic stenosis.
Why the study?
The optimal timing for aortic valve replacement in aortic stenosis remains controversial and may be guided by markers of adverse left ventricular remodeling.
Does the presence of ECG strain pattern predict adverse LV remodeling and myocardial fibrosis in patients with severe aortic stenosis?
Observational (n=83)
No
Does the presence of ECG strain pattern predict adverse LV remodeling and myocardial fibrosis in patients with severe aortic stenosis?
Odds Ratio: 7.1 (95% CI 1.46–34.48)
p-value: p=0.015
ECG strain pattern in severe aortic stenosis is a marker of adverse structural and functional LV remodeling and interstitial myocardial fibrosis, and its persistence after AVR indicates more advanced baseline LV injury.
ECG strain may identify advanced fibrosis in severe AS; leaves open prospective validation for risk stratification or AVR timing.
Background. The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain patterns in relation to adverse LV remodeling and myocardial fibrosis. Methods. A total of 83 symptomatic severe AS patients (age 66.5 ± 8.6, 42% male) scheduled for surgical AVR underwent preoperative cardiovascular magnetic resonance (CMR) with T1 mapping and echocardiography with global longitudinal strain (GLS) analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies (71) sampled at the time of AVR. The 12-lead ECG was performed preoperatively and 3 and 12 months postoperatively. Results. ECG strain-positive patients (prevalence of 43.4%) had more severe AS, increased LV mass, higher levels of brain natriuretic peptides (BNP) and high-sensitivity troponin I, lower GLS, and lower LV ejection fraction (LVEF). Patients with ECG strain had more diffuse fibrosis, as evident by higher native T1 values (974.8 ± 33.6 ms vs 946.5 ± 28.2 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46–34.48, p = 0.015). Patients with persistent ECG strain at 1 year following AVR had larger LV volumes and mass, lower GLS, lower LVEF, higher BNP levels, and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Conclusion. ECG strain is a marker of adverse structural and functional LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.
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Balčiūnaitė et al. (2023) conducted an observational in Severe symptomatic aortic stenosis (n=83). ECG strain pattern vs. No ECG strain pattern was evaluated on Increased left ventricular mass index (OR 7.10, 95% CI 1.46-34.48, p=0.015). The presence of an ECG strain pattern was an independent predictor of increased left ventricular mass index (OR 7.10) and was associated with more diffuse myocardial fibrosis in patients with severe aortic stenosis.
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