Electrocardiographic strain pattern is a major determinant of rehospitalization for heart failure after Transcatheter Aortic-Valve Replacement

Abstract

Electrocardiographic (ECG) strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis (AS) and after surgical aortic-valve replacement (AVR). However, the relation linking ESP and cardiovascular MACE in patients with transcatheter aortic-valve replacement (TAVR) has not been yet described. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after TAVR. A total of 585 patients with severe AS (mean age: 83 ± 7 years; male 39.8%) were enrolled for TAVR from November 2012 to May 2018. ESP was defined as ≥ 1 mm concave down-sloping ST-segment depression and asymmetrical T-wave inversion in the lateral leads. Patients with baseline left bundle branch block (LBBB), right bundle branch block (RBBB) or ventricular paced rhythm were excluded. The primary endpoints of the study were the overall all-cause mortality after TAVR, rehospitalization for hearth failure (HF), myocardial infarction and stroke. 178 (30.4%) patients were excluded owing to LBBB ( n = 103) or RBBB ( n = 75). Among the 407 remaining patients, 106 had ESP (26.04%). Patients with ESP were younger, had lower BMI and more severe AS and significant lower LVEF. At a median follow-up of 608 days (356–895), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for HF was significantly higher (33 (31.1%) vs. 33 (11%); P < 0.001) in ESP patients. By multivariate analyses, ESP remained a strong predictor of rehospitalization for hearth failure (HR 2.747 (95% CI 1.614–4.674); P < 0.001). In patients with AS eligible for TAVR, ESP is frequent and associated with an increased risk of post interventional heart failure regardless of preoperative LVH. ESP represents an easy, objective, reliable and low-cost tool to identify patients who may benefit from intensified post-interventional follow-up.