Valvular heart disease
Differences in Cardiovascular Risk Profile Between Electrocardiographic Hypertrophy Versus Strain in Asymptomatic Patients With Aortic Stenosis (from SEAS Data)

https://doi.org/10.1016/j.amjcard.2011.03.084Get rights and content

Electrocardiograms are routinely obtained in clinical follow-up of patients with asymptomatic aortic stenosis (AS). The association with aortic valve, left ventricular (LV) response to long-term pressure load, and clinical covariates is unclear and the clinical value is thus uncertain. Data from clinical examination, electrocardiogram, and echocardiogram in 1,563 patients in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study were used. Electrocardiograms were Minnesota coded for arrhythmias and atrioventricular and intraventricular blocks; LV hypertrophy was assessed by Sokolow–Lyon voltage and Cornell voltage–duration criteria; and strain by T-wave inversion and ST-segment depression. Degree of AS severity was evaluated by echocardiography as peak aortic jet velocity and LV mass was indexed by body surface area. After adjustment for age, gender, LV mass index, heart rate, systolic and diastolic blood pressures, blood glucose, digoxin, antiarrhythmic drugs, drugs acting on the renin–angiotensin system, diuretics, β blockers and calcium receptor blockers; peak aortic jet velocity was significantly greater in patients with electrocardiographic strain (mean difference 0.13 m/s, p <0.001) and LV hypertrophy by Sokolow–Lyon voltage criteria (mean difference 0.12 m/s, p = 0.004). After similar adjustment, LV mass index was significantly greater in patients with electrocardiographic strain (mean difference 14.8 g/cm2, p <0.001) and LV hypertrophy by Sokolow–Lyon voltage criteria and Cornell voltage–duration criteria (mean differences 8.8 and 17.8 g/cm2, respectively, p <0.001 for the 2 comparisons). In multiple comparisons patients with electrocardiographic strain had increased peak aortic jet velocity, blood glucose, and uric acid, whereas patients with LV hypertrophy by Sokolow–Lyon voltage criteria were younger and patients with LV hypertrophy by Cornell voltage–duration criteria more often were women. In conclusion, electrocardiographic criteria for LV hypertrophy and strain are independently associated with peak aortic jet velocity and LV mass index. Moreover, clinical covariates differ significantly between patients with electrocardiographic strain and those with LV hypertrophy by Sokolow–Lyon voltage criteria and Cornell voltage–duration criteria.

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Methods

All data were from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, a multicenter, double-blind, placebo-controlled study investigating whether randomizing 1,873 patients (45 to 85 years of age) with asymptomatic AS (defined as echocardiographic aortic valve thickening accompanied by Doppler-measured aortic peak flow velocity ≥2.5 and ≤4.0 m/s, normal LV systolic function, and absence of symptoms according to independent local investigators based on patient interviews) to

Results

Electrocardiographic data were available for 1,563 patients (958 men, 61.4%; 605 women, 38.7%; mean age 67.4 ± 9.6 years) and echocardiographic data were available for 1,471 of these patients. Patients' mean peak aortic jet velocity was 3.1 ± 0.5 m/s (Table 1). Although the predefined inclusion criterion was peak aortic jet velocity ≥2.5 to ≤4.0 m/s, 84 patients had peak aortic jet velocity >4.0 m/s (severe AS) determined at echocardiographic proof reading in the core laboratory. Differences in

Discussion

This is the first large study to describe how electrocardiographic variables relate to peak aortic jet velocity, the LV and clinical covariates in asymptomatic patients with AS and several findings add to current knowledge. First, peak aortic jet velocity is, independent of echocardiographic LV mass index and clinical covariates, significantly increased in patients with electrocardiographic strain and LV hypertrophy by Sokolow–Lyon voltage criteria. Second, LV mass index is, independent of peak

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The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study was conducted with financial support from Merck & Co., Inc Whitehouse Station, New Jersey.

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