Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

Anders M Greve; Kurt Boman; Christa Gohlke-Baerwolf; Y Antero Kesäniemi; Christoph Nienaber; Simon Ray; Kenneth Egstrup; Anne B Rossebø; Richard B Devereux; Lars Køber; Ronnie Willenheimer; Kristian Wachtell

doi:10.1161/CIRCULATIONAHA.111.049759

Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

Anders M Greve, Kurt Boman, Christa Gohlke-Baerwolf, Y Antero Kesäniemi, Christoph Nienaber, Simon Ray, Kenneth Egstrup, Anne B Rossebø, Richard B Devereux, Lars Køber, Ronnie Willenheimer, Kristian Wachtell

46 Citationer (Scopus)

Abstract

Background - The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described. Methods and Results - Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V ₄ through V ₆) and LVH, assessed by Sokolow-Lyon voltage criteria (R _V5-6+S _V1 ≥35 mV) and Cornell voltage-duration criteria {[RaVL+S _V3+(6 mV in women)]×QRS duration ≥2440 mV · ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3±0.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4-6.8; P=0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0-16.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3-3.1; both P=0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3-4.9; P=0.008). Conclusions - ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.

Originalsprog	Engelsk
Tidsskrift	Circulation
Vol/bind	125
Sider (fra-til)	346-353
ISSN	0009-7322
DOI	https://doi.org/10.1161/CIRCULATIONAHA.111.049759
Status	Udgivet - 17 jan. 2012

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10.1161/CIRCULATIONAHA.111.049759

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Greve, A. M., Boman, K., Gohlke-Baerwolf, C., Kesäniemi, Y. A., Nienaber, C., Ray, S., Egstrup, K., Rossebø, A. B., Devereux, R. B., Køber, L., Willenheimer, R., & Wachtell, K. (2012). Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study. Circulation, 125, 346-353. https://doi.org/10.1161/CIRCULATIONAHA.111.049759

Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study. / Greve, Anders M; Boman, Kurt; Gohlke-Baerwolf, Christa et al.

I: Circulation, Bind 125, 17.01.2012, s. 346-353.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Greve, AM, Boman, K, Gohlke-Baerwolf, C, Kesäniemi, YA, Nienaber, C, Ray, S, Egstrup, K, Rossebø, AB, Devereux, RB, Køber, L, Willenheimer, R & Wachtell, K 2012, 'Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study', Circulation, bind 125, s. 346-353. https://doi.org/10.1161/CIRCULATIONAHA.111.049759

@article{d5fec5b3e20a4f119c1d17c0ad66cf51,

title = "Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study",

abstract = "Background - The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described. Methods and Results - Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V 4 through V 6) and LVH, assessed by Sokolow-Lyon voltage criteria (R V5-6+S V1 ≥35 mV) and Cornell voltage-duration criteria {[RaVL+S V3+(6 mV in women)]×QRS duration ≥2440 mV · ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3±0.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4-6.8; P=0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0-16.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3-3.1; both P=0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3-4.9; P=0.008). Conclusions - ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.",

author = "Greve, {Anders M} and Kurt Boman and Christa Gohlke-Baerwolf and Kes{\"a}niemi, {Y Antero} and Christoph Nienaber and Simon Ray and Kenneth Egstrup and Rosseb{\o}, {Anne B} and Devereux, {Richard B} and Lars K{\o}ber and Ronnie Willenheimer and Kristian Wachtell",

year = "2012",

month = jan,

day = "17",

doi = "10.1161/CIRCULATIONAHA.111.049759",

language = "English",

volume = "125",

pages = "346--353",

journal = "Circulation",

issn = "0009-7322",

publisher = "AHA/ASA",

}

TY - JOUR

T1 - Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

AU - Greve, Anders M

AU - Boman, Kurt

AU - Gohlke-Baerwolf, Christa

AU - Kesäniemi, Y Antero

AU - Nienaber, Christoph

AU - Ray, Simon

AU - Egstrup, Kenneth

AU - Rossebø, Anne B

AU - Devereux, Richard B

AU - Køber, Lars

AU - Willenheimer, Ronnie

AU - Wachtell, Kristian

PY - 2012/1/17

Y1 - 2012/1/17

N2 - Background - The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described. Methods and Results - Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V 4 through V 6) and LVH, assessed by Sokolow-Lyon voltage criteria (R V5-6+S V1 ≥35 mV) and Cornell voltage-duration criteria {[RaVL+S V3+(6 mV in women)]×QRS duration ≥2440 mV · ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3±0.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4-6.8; P=0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0-16.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3-3.1; both P=0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3-4.9; P=0.008). Conclusions - ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.

AB - Background - The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described. Methods and Results - Data were obtained in asymptomatic patients randomized to simvastatin/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V 4 through V 6) and LVH, assessed by Sokolow-Lyon voltage criteria (R V5-6+S V1 ≥35 mV) and Cornell voltage-duration criteria {[RaVL+S V3+(6 mV in women)]×QRS duration ≥2440 mV · ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3±0.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4-6.8; P=0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0-16.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3-3.1; both P=0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3-4.9; P=0.008). Conclusions - ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.

U2 - 10.1161/CIRCULATIONAHA.111.049759

DO - 10.1161/CIRCULATIONAHA.111.049759

M3 - Journal article

C2 - 22147903

SN - 0009-7322

VL - 125

SP - 346

EP - 353

JO - Circulation

JF - Circulation

ER -

Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients with Aortic Stenosis: The Simvastatin and Ezetimibe in Aortic Stenosis Study

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