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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MDPI AG
2023-05-01
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| Online Access: | https://www.mdpi.com/2075-1729/13/6/1234 |
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| author | Maria Drakopoulou Georgios Oikonomou Anastasios Apostolos Maria Karmpalioti Chryssa Simopoulou Leonidas Koliastasis George Latsios Andreas Synetos Georgios Benetos George Trantalis Skevos Sideris Polychronis Dilaveris Costas Tsioufis Konstantinos Toutouzas |
| author_facet | Maria Drakopoulou Georgios Oikonomou Anastasios Apostolos Maria Karmpalioti Chryssa Simopoulou Leonidas Koliastasis George Latsios Andreas Synetos Georgios Benetos George Trantalis Skevos Sideris Polychronis Dilaveris Costas Tsioufis Konstantinos Toutouzas |
| author_sort | Maria Drakopoulou |
| collection | DOAJ |
| 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 <i>p</i> = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square <i>p</i> = 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. |
| first_indexed | 2024-03-11T02:14:25Z |
| format | Article |
| id | doaj.art-66525f47a44144658e06f493779ebef1 |
| institution | Directory Open Access Journal |
| issn | 2075-1729 |
| language | English |
| last_indexed | 2024-03-11T02:14:25Z |
| publishDate | 2023-05-01 |
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| series | Life |
| spelling | doaj.art-66525f47a44144658e06f493779ebef12023-11-18T11:16:28ZengMDPI AGLife2075-17292023-05-01136123410.3390/life13061234The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT TrialMaria Drakopoulou0Georgios Oikonomou1Anastasios Apostolos2Maria Karmpalioti3Chryssa Simopoulou4Leonidas Koliastasis5George Latsios6Andreas Synetos7Georgios Benetos8George Trantalis9Skevos Sideris10Polychronis Dilaveris11Costas Tsioufis12Konstantinos Toutouzas13First Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceState Department of Cardiology, Hippokration General Hospital, 11256 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Cardiology Department, Hippokration Hospital, Athens Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceBackground: 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 <i>p</i> = 0.022). There was no difference between the strain and no strain group regarding the performance of pre-dilatation (21 vs. 33, chi-square <i>p</i> = 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.https://www.mdpi.com/2075-1729/13/6/1234electrocardiographic strain patterntranscatheter aortic valve implantationself-expanding valve |
| spellingShingle | Maria Drakopoulou Georgios Oikonomou Anastasios Apostolos Maria Karmpalioti Chryssa Simopoulou Leonidas Koliastasis George Latsios Andreas Synetos Georgios Benetos George Trantalis Skevos Sideris Polychronis Dilaveris Costas Tsioufis Konstantinos Toutouzas The Role of ECG Strain Pattern in Prognosis after TAVI: A Sub-Analysis of the DIRECT Trial Life electrocardiographic strain pattern transcatheter aortic valve implantation self-expanding valve |
| 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 | electrocardiographic strain pattern transcatheter aortic valve implantation self-expanding valve |
| url | https://www.mdpi.com/2075-1729/13/6/1234 |
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