1. Clinical Significance of Electrocardiographic Markers of Myocardial Damage prior to Aortic Valve Replacement Running Title: ECG Strain, bundle branch block and aortic valve stenosis
- Author
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Coisne, Augustin, Ninni, Sandro, Pontana, François, Aghezzaf, Samy, Janvier, Florent, Mouton, Stéphanie, Ridon, Hélène, Ortmans, Staniel, Seunes, Claire, Wautier, Marine, Coppin, Amandine, Madika, Anne-Laure, Boutie, Bertrand, Koussa, Mohamad, Bical, Antoine, Vincentelli, André, Juthier, Francis, Loobuyck, Valentin, Sudre, Arnaud, Marchetta, Stella, Martinez, Christophe, Staels, Bart, Lancellotti, Patrizio, Modine, Thomas, Montaigne, David, Récepteurs nucléaires, maladies cardiovasculaires et diabète - U 1011 (RNMCD), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Department of Clinical Physiology and Echocardiography (CHU Lille), Department of Cardiovascular Medicine (CHU Lille), Department of Cardiovascular Radiology (CHU Lille), Department of Cardiovascular Surgery (CHU Lille), Gruppo Villa Maria Care and Research [Bari, Italy], Anthea Hospital [Bari, Italy], Service de cardiologie [Liège], CHU de Liège-Domaine Universitaire du Sart Tilman, Department of Biology (CHU Lille), and Derudas, Marie-Hélène
- Subjects
[SDV] Life Sciences [q-bio] ,Aortic stenosis ,ECG strain ,[SDV]Life Sciences [q-bio] ,cardiovascular diseases ,Aortic valve replacement ,Myocardial damage - Abstract
International audience; Background: Pre-operative myocardial fibrosis and remodeling impact on outcomes after aortic valve replacement (AVR). We aimed at investigating the prognostic impact of preoperative electrocardiographic (ECG) markers of left ventricular (LV) myocardial damage, i.e. bundle branch block (BBB) and ECG strain pattern after (surgical or transcatheter) AVR for severe aortic stenosis (AS).Methods: Between April 2008 and October 2017, we explored consecutive patients referred to our Heart Valve Clinic for first AVR for severe AS. Detailed pre-operative phenotyping and ECG analysis were performed. Patients were followed-up after AVR for major cardiac events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke.Results: BBB and ECG strain were respectively observed in 13.5 and 21% of the 1122 patients included. These ECG markers identified a subgroup of older patients, with higher NYHA class and more advanced myocardial disease as detected by echocardiography, i.e. higher LV mass and lower LV ejection fraction, global longitudinal strain and integrated backscatter, than patients without ECG strain or BBB. ME occurred in 212 (18.6%) patients during a mean follow-up of 4.4 ± 1.5 years with higher incidence in case of ECG strain or BBB (HR 1.56, 95%CI 1.13-2.14, p = 0.006; HR 1.47, 95%CI 1.02-2.13, p = 0.04 respectively). The prognostic value of ECG strain remained significant after adjustment for age, diabetes and pre-operative LVEF.Conclusions: Pre-operative ECG markers of myocardial damage identify a subgroup of AS patients at high risk of post-AVR cardiovascular complications irrespective of other prognostic factors and should help the multiparametric staging of cardiac damage to guide AVR.
- Published
- 2020