ECG Strain Research Articles

The Additional Diagnostic Value of Electrocardiogram and Strain Patterns in Transplanted Patients

Background: Transplanted patients are frail individuals who may be affected by diastolic dysfunction, leading to a decrease in exercise tolerance. Previous studies have reported that certain ECG and echocardiographic parameters (such as the P-wave interval, PQ interval, P-wave dispersion, Tend-P interval, QTc interval, and strain) can support the diagnosis of diastolic dysfunction when the ejection fraction is preserved. This study aimed to examine the potential diagnostic contribution of specific ECG and deformation parameters in transplanted recipients, who are at a high risk of heart failure. Materials and Methods: A group of 33 transplanted subjects (17 renal and 16 liver) were categorized using two scores for heart failure with preserved ejection fraction (HFpEF). Additionally, they underwent evaluation based on ECG parameters (P-wave interval, PQ interval, Pwave dispersion, and Tend-P QTc) and echocardiographic deformation parameters (strain and twist). The Student’s t-test was used for statistical analysis. Results: The two scores identified different numbers of excludable and not excludable subjects potentially affected by HFpEF. The not excludable group presented ECG parameters with significantly higher values (P-wave, PQ interval, posterior wall diastole, and Tend-P, all with p ≤ 0.05) and significantly lower 4D strain and twist values (p < 0.05) Conclusions: There is evidence for a significant diagnostic contribution of additional ECG and echo strain parameters in an early phase of diastolic dysfunction in subjects potentially affected by HFpEF.

Diagnostic value of left ventricle strain pattern of hypertensive patients in coronary and cerebrovascular diseases

Association of Electrocardiographic Left Ventricular Strain Pattern with Coronary Artery Disease and Cerebrovascular Accident in Hypertensive Patients
 Background: Patients diagnosed with hypertension and left ventricular hypertrophy could presented with electrocardiographic changes including criteria of left ventricular hypertrophy, and left ventricular strain pattern( fixed ST depression and T inversion in leads I, avL, V5&6)
 Objective: To study the impact of electrocardiographic left ventricular strain pattern in hypertensive patient as predictor for coronary artery disease and cerebrovascular accident development.
 Material and method: a cross sectional hospital based study was conducted during 2012-2017 at Iraqi center for heart diseases including hypertensive patients with normal ECG or LV strain pattern criteria, all patients underwent echocardiography and coronary angiography and the data were collected from patients’ files.
 Results: The records of 401 hypertensive patients [262(65.3%) males/139(34.7%) females] were included in this study. Their mean age was 60.07 ± 10.8 year.
 The relation between electrocardiographic left ventricular strain pattern and Coronary Angiography among patients was significant (P <0.001).
 There was a significant difference between electrocardiographic left ventricular strain pattern and cerebrovascular accident among studied group (P<0.001).
 Conclusions: electrocardiographic left ventricular strain in hypertensive patients is highly associated with coronary artery disease and cerebrovascular accident.
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P1481STRAIN REPOLARISATION ON ECG, NOT LEFT VENTRICULAR MASS, ASSOCIATES WITH CARDIOVASCULAR OUTCOMES IN A PROSPECTIVE COHORT OF HAEMODIALYSIS PATIENTS

Abstract Background and Aims Cardiovascular disease is common in chronic and end stage kidney disease. Left ventricular hypertrophy (LVH) has been identified as contributor to cardiovascular risk in this population. The aim of the study was to assess whether the combined use of electrocardiography and echocardiography in assessing LVH in a haemodialysis population can provide improved risk stratification. Method Prospective study of 192 prevalent maintenance haemodialysis ( HD) patients 12 lead ECGs were performed on a mid week non –dialysis day. Electrocardiographic strain was defined as a down slopping convex ST segment with inverted T waves in leads V5 and / or V6. Transthoracic echocardiographic was performed immediately after ECG .LV mass was indexed to body surface area (LVMIBSA). LVH was determined if LVMI >116g/m2 for male patients, and >100g/m2 for female patients. The primary study endpoint was major cardiac events (MACE). A secondary endpoint was all cause mortality. Results 192 patients included in the final analysis, 137 (71.4%) male.. The mean ejection fraction (EF) was 60.6± 11.1 % and the mean LVMI (BSA) was 115.0± 36.8 g/m2. During a mean follow up period of 2.4 ± 1.0 years, 50 patients reached a MACE end point and 62 patients died. On univariate Cox regression analysis, the factors associated with MACE were the presence of ECG strain (HR 2.961, CI: 1.254 – 6.990, p= 0.013)) URR (HR 0.968, CI: 0.942 – 0.994, p=0.015) and history of CAD (HR: 2.397 CI: 1.363 -4.2515, p= 0.002). In multivariate Cox regression analysis adjusting for baseline cardiovascular phenotype and dialysis parameters ECG strain remained significantly associated with MACE. Conclusion The presence of electrocardiographic strain increases the risk for MACE independently of LVH in haemodialysis patients. ECG strain has potential to be a simple bedside prognostic biomarker and even therapeutic target in haemodialysis patients.

P6485Incremental prognostic value of electrocardiographic strain after transcatheter aortic valve replacement for aortic stenosis

Abstract Background Electrocardiographic (ECG) strain pattern has recently been associated with increased adverse outcome in aortic stenosis (AS) and after surgical aortic valve replacement (AVR). However, the relation linking ECG strain and cardiovascular MACE in patients with transcatheter aortic valve replacement (TAVR) has not been yet described. Objectives The aim of our study was to determine the impact and incremental value of ECG Strain pattern in predicting adverse outcome after TAVR. Methods 585 patients with severe AS (mean age: 83±7 male 39.8%) were enrolled from November 2012 to May 2018. ECG strain pattern 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. All patients underwent transthoracic echocardiography (TTE) before TAVR and at 30 days follow up. The primary endpoints of the study were the overall all-cause mortality after TAVR, rehospitalization for Hearth failure (HF), myocardial infarction and stroke. Results 178 (30.4%) patients were excluded from analyses owing to the presence of either LBBB (n=103) or RBBB (n=75). Among the 407 remaining patients, 106 had ECG strain pattern (26.04%). Patients with ECG strain were significantly younger (81.6±8 years vs 83.5±6.8 years; p=0.022), had lower BMI (23±4.5 kg.m2 vs 27.9±6.8 kg.m2; p=0.02) more severe AS (mean gradient 52.3±15.2 mmHg vs 47.9±11.8 mmHg; p=0.003), significant lower LVEF (51.8±15% vs 58.4±10.7%; p<0.001). Left ventricular hypertrophy (LVH) was more frequent in patients with ECG Strain (indexed left ventricular mass (135.9±33.4 g.m2 vs 123.6±31.9 g.m2; p=0.002)). Death from any cause (22 (20.8%) vs 61 (20.3%); p=0.508) did not differ significantly between groups. Major adverse cardiovascular events (MACE) including death, stroke and heart failure at 1 month showed similar incidence (7 (6.6%) vs 17 (5.6%), p=0.439). Rehospitalization for hearth failure (HF) was significantly higher (33 (31.1%) vs 33 (11%); p<0.001) in patients with ECG strain pattern. In univariate model, ECG Strain was a strong predictor of rehospitalization for HF (HR 2.621 95% CI (1.607–4.277), p=0.001), independently of LVH assessed either by ECG criteria (HR 1.181 95% CI (0.698–1.997; p=0.536) or TTE (HR 1.557 95% (CI 0.701–3.458; p=0.277). ECG Strain remained associated with a higher risk of rehospitalization for hearth failure in multivariate analyses (HR 2.747 95% (CI 1.614- 4.674); p<0.001) Conclusion In patients with AS eligible for TAVR, ECG Strain Pattern is frequent and associated with an increased risk of post interventional heart failure regardless of preoperative LVH. ECG Strain pattern represents an easy, objective, reliable and low-cost tool to identify patients who may benefit from an extend and intensified post-interventional follow-up.

Electrocardiographic Strain Pattern Is Associated With Left Ventricular Concentric Remodeling, Scar, and Mortality Over 10Years: The Multi-Ethnic Study of Atherosclerosis.

BackgroundBoth ECG strain pattern and QRS measured left ventricular (LV) hypertrophy criteria are associated with LV hypertrophy and have been used for risk stratification. However, the independent predictive value of ECG strain in apparently healthy individuals in predicting mortality and adverse cardiovascular events is unclear.Methods and ResultsMESA (Multi‐Ethnic Study of Atherosclerosis) is a multicenter, prospective cohort of 6441 participants (mean age, 62 years; 54% women). In 2847 of these participants, cardiac magnetic resonance imaging was repeated ≈10 years later (Year‐10). At Year‐10, 1759 participants underwent cardiac magnetic resonance imaging with gadolinium to detect myocardial scar. During a median follow‐up of 11.7 years, ECG strain (n=168, 2.6%) was significantly associated with all‐cause death (adjusted hazard ratio, 1.33; 95% confidence interval, 1.01–1.77; P=0.045), heart failure (2.62; 1.73–3.97; P<0.001), myocardial infarction (1.86; 1.09–3.18; P=0.024), and incident cardiovascular disease (1.45; 1.06–2.00; P=0.022). ECG strain was also associated with an increase in LV mass (β=9.29 g; P<0.001) and LV mass‐to‐volume ratio (β=0.07 g/mL; P=0.007) and a decline in LV ejection fraction (β=−3.30%; P<0.001). Moreover, ECG strain either at baseline and Year‐10 was associated with LV scar (odds ratio, 4.93 and 5.22; P=0.002 and <0.001, respectively), whereas these associations were not observed in ECG LV hypertrophy.ConclusionsECG strain is independently associated with all‐cause mortality, adverse cardiovascular events, development of LV concentric remodeling and systolic dysfunction, and myocardial scar over 10 years in multiethnic participants without past cardiovascular disease. ECG strain may be an early marker of LV structural remodeling that contributes to development of adverse cardiovascular events.Clinical Trial RegistrationURL: https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.

OP.7B.06] RELATIONSHIP OF INCIDENT ATRIAL FIBRILLATION TO THE ELECTROCARDIOGRAPHIC STRAIN PATTERN IN HYPERTENSIVE PATIENTS WITH ELECTROCARDIOGRAPHIC LEFT VENTRICULAR HYPERTROPHY

Objective: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH), and both regression of ECG-LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular morbidity and mortality, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Design and method: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG-LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs. atenolol-based treatment. Results: During 4.7 ± 1.1 yrs. of follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-yr. incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p < 0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34–2.06, p < 0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09–1.76, p = 0.008). Conclusions: The presence of baseline ECG strain is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG-LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed for development of new AF.

128 Genomic insights of ecg strain patten in aortic stenosis: t wave inversion and st-segment depression are underlined by different molecular pathways

BackgroundECG strain pattern is frequently presented in AS patients as a marker of LV hypertrophy and is emerging as one of the predictors for AVR. Our previous study had demonstrated...

Abstract 11359: Relationship of Incident Atrial Fibrillation to the Electrocardiographic Strain Pattern in Hypertensive Patients With Electrocardiographic Left Ventricular Hypertrophy

Background: Atrial fibrillation (AF) is strongly related to hypertension and to left ventricular hypertrophy (LVH) and both regression of ECG LVH and achievement of lower systolic blood pressure (SBP) are associated with lower incidence of AF. The ECG strain pattern of lateral ST depression and T-wave inversion has been associated with more severe LVH, decreased LV systolic function and an increased risk of cardiovascular mortality and morbidity, including new heart failure (HF). However, whether ECG strain is associated with an increased risk of new AF is unclear. Methods: Risk of new-onset AF was examined in relation to the presence of the strain pattern on baseline ECG in 7921 hypertensive patients with ECG LVH with no history of AF, who were in sinus rhythm on their baseline ECG, had baseline strain determination and were randomized to losartan- vs atenolol-based treatment. Results: During 4.7±1.1 years follow-up, new-onset AF was diagnosed in 621 patients (7.8%). Baseline ECG strain was present in 882 patients (11.1%) and was associated with a significantly higher 5-year incidence of AF in Kaplan-Meier estimates (12.2 vs 7.4%, p&lt;0.001) and with a 66% greater risk of new AF in a univariate Cox model (HR 1.66, 95% CI 1.34-2.06, p&lt;0.001), compared with the absence of ECG strain. After adjusting for other univariate predictors of new AF in this population, including age, sex, race, prior anti-hypertensive treatment, randomized treatment allocation, prevalent diabetes, history of ischemic heart disease, prior myocardial infarction, stroke or HF, baseline serum cholesterol and urine albumin/creatinine ratio entered as standard covariates and incident HF and on-treatment diastolic BP, SBP, heart rate and Cornell product LVH entered as time-varying covariates, ECG strain remained associated with a 39% greater risk of new-onset AF (HR 1.39, 95% CI 1.09-1.76, p=0.008). Conclusions: The presence of strain on a baseline ECG is strongly associated with an increased risk of developing new-onset AF in hypertensive patients with ECG LVH, independent of other AF risk factors and the effects of incident HF, LVH regression and SBP reduction. These findings suggest that hypertensive patients with ECG strain should be followed closely for development of new AF.

Value of the electrocardiographic strain pattern in children and adolescents with end stage renal disease

BackgroundAmong several electrocardiographic LVH criteria, LVH strain pattern was implicated as the strongest marker of cardiovascular adverse outcomes in general population and hypertensives. ObjectiveThe aim of this work is to detect the prevalence, clinical relevance and determinants of ECG strain pattern presence in children and adolescents with ESRD. MethodsThe study was performed at Zagazig University Hospital during the year 2012–2013. The studied patients with ESRD undergoing hemodialysis (24 males and 26 females) were categorized into three groups according to ECG. All patients were subjected to laboratory investigations (albumin, fasting lipids, renal function, serum creatinine, K+ serum, Ca2+ serum, phosphorus serum, alkaline phosphatase [ALP] serum, hemoglobin, pro BNP and parathormone), standard 12 leads surface ECG, and echocardiography (ECHO). ResultsECG strain was the most prevalent electrocardiographic pattern among the studied patients (42% versus 26% normal ECG and 32% ECG LVH without strain) who clinically have more ischemic chest pain (81% in group III versus 23.1% in group I and 43.8% in group III, p=0.003) and systolic hypertension (p=0.006). The prolonged disease duration (p=0.005), increased LVM (p=0.007), higher TC (p<0.01), lower Hb (p=0.02) and increased internal carotid velocity (p=0.05) were the independent variables associated with the ECG strain pattern. ConclusionIdentification of ECG strain pattern is correlated with myocardial ischemia risk, so it could be helpful in risk stratification of children and adolescents with ESRD. Factors determining ECG strain are prolonged disease duration, increased LVM, higher TC, lower Hb and increased internal carotid velocity could become an important part of management of ESRD patients.

Abstract 13080: Electrocardiographic Strain Pattern as a Predictor for New-Onset Heart Failure, Concentric Hypertrophy, Reduced Function, and Scar: MESA (Multi-Ethnic Study of Atherosclerosis)

Introduction: Left ventricular hypertrophy (LVH) is associated with incident heart failure (HF), and ECG strain is a marker of LVH. This study sought to evaluate the relationship of baseline ECG strain to the incidence of HF, longitudinal change of left ventricular (LV) geometry and function by cardiac magnetic resonance imaging (CMR). Methods: A total of 4,732 participants (mean age 61 years, 54% women) free of cardiovascular disease (CVD) underwent ECG and CMR. We used univariable and multivariable Cox proportional hazards to evaluate the association of ECG strain with incident HF (n=137). We also examined the association of baseline ECG strain with changes of LV geometry and function in 2,846 participants imaged at baseline and 10 years later using multiple linear regression models. Finally, we evaluated the association between the presence of ECG strain and LV scar defined by late Gadolinium enhancement at year 10 (n=1,650). Results: The presence of ECG strain was significantly associated with incident HF (hazard ratio: 2.53; 95% CI: 1.40 to 4.57; p=0.021) during follow-up (median 11.2 years). Longitudinal analysis revealed that the presence of ECG strain at baseline was significantly associated with an increase in the LV mass index (β=5.54g/m2, p&lt;0.001), LV mass-to-volume ratio (β=0.07g/mL, p=0.009), and a decrease in LV ejection fraction (EF) (β=-2.35%, p=0.015), even when coronary heart disease events were excluded. Moreover, ECG strain was independently associated with LV scar (p=0.004). Conclusions: In a cohort of middle-aged participants without prior CVD, ECG strain was an independent predictor of new-onset HF. In addition, ECG strain was related to development of LV concentric hypertrophy and decline in EF as well as LV scar.

Left ventricular hypertrophy with strain and aortic stenosis.

ECG left ventricular hypertrophy with strain is associated with an adverse prognosis in aortic stenosis. We investigated the mechanisms and outcomes associated with ECG strain. One hundred and two patients (age, 70 years [range, 63-75 years]; male, 66%; aortic valve area, 0.9 cm(2) [range, 0.7-1.2 cm(2)]) underwent ECG, echocardiography, and cardiovascular magnetic resonance. They made up the mechanism cohort. Myocardial fibrosis was determined with late gadolinium enhancement (replacement fibrosis) and T1 mapping (diffuse fibrosis). The relationship between ECG strain and cardiovascular magnetic resonance was then assessed in an external validation cohort (n=64). The outcome cohort was made up of 140 patients from the Scottish Aortic Stenosis and Lipid Lowering Trial Impact on Regression (SALTIRE) study and was followed up for 10.6 years (1254 patient-years). Compared with those without left ventricular hypertrophy (n=51) and left ventricular hypertrophy without ECG strain (n=30), patients with ECG strain (n=21) had more severe aortic stenosis, increased left ventricular mass index, more myocardial injury (high-sensitivity plasma cardiac troponin I concentration, 4.3 ng/L [interquartile range, 2.5-7.3 ng/L] versus 7.3 ng/L [interquartile range, 3.2-20.8 ng/L] versus 18.6 ng/L [interquartile range, 9.0-45.2 ng/L], respectively; P<0.001) and increased diffuse fibrosis (extracellular volume fraction, 27.4±2.2% versus 27.2±2.9% versus 30.9±1.9%, respectively; P<0.001). All patients with ECG strain had midwall late gadolinium enhancement (positive and negative predictive values of 100% and 86%, respectively). Indeed, late gadolinium enhancement was independently associated with ECG strain (odds ratio, 1.73; 95% confidence interval, 1.08-2.77; P=0.02), a finding confirmed in the validation cohort. In the outcome cohort, ECG strain was an independent predictor of aortic valve replacement or cardiovascular death (hazard ratio, 2.67; 95% confidence interval, 1.35-5.27; P<0.01). ECG strain is a specific marker of midwall myocardial fibrosis and predicts adverse clinical outcomes in aortic stenosis.

Effects of isolated obesity on left ventricular function: a longitudinal strain imaging study

BackgroundObesity is associated with heart failure, cardiovascular morbidity, and mortality. A direct effect of weight on left ventricular (LV) structure and myocardial function is not well established.AimThe aim of this study was to determine the effect of isolated obesity on LV morphology and systolic function using LV standard ECG indices and strain imaging indices.Patients and methodsSixty-five individuals were enrolled into this study: 45 with isolated obesity, defined as a BMI of 30 kg/m 2 or higher with no other cardiovascular comorbidities, and 20 nonobese age-adjusted and sex-adjusted controls. All participants underwent standard two-dimensional ECG and myocardial strain imaging.ResultsThere was no significant difference between patients and controls as regards height (P > 0.05). In contrast, weight, BMI, and waist circumference were significantly higher in the patient group compared with the control group (P < 0.001). Obese participants had significantly increased left atrial diameter, aortic diameter, septal wall thickness, LV posterior wall thickness, and LV mass (P < 0.001). There was no significant difference between patients and controls as regards LV diastolic diameter, LV systolic diameter, ejection fraction, fractional shortening, LV mass index, E velocity, A velocity, and the E/A ratio (P > 0.05). Comparative analysis of LV two-dimensional longitudinal strain parameters between patients and controls shows a significant decrease in longitudinal strain in obese patients in the apical long-axis, apical four-chamber, and apical two-chamber views (P < 0.001).ConclusionObesity is associated with morphologic alterations in the LV, in the form of increased LV mass, interventricular septum thickness, and LV posterior wall thickness, as well as subclinical changes in LV systolic function, which can be detected by strain imaging even without overt heart disease.

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<i>Circulation</i> Editors’ Picks

Left ventricular hypertrophy and outcomes: A five-year retrospective analysis of patients with essential hypertension

Left ventricular hypertrophy (LVH) is the most important element of cardiovascular continuum in patients with essential hypertension (EH). The results of a five-year retrospective analysis of EH patients cohort with initially different types of left ventricular geometry (491 subjects) are presented. It is shown that the overall mortality in patients with concentric and eccentric LVH does not differ significantly (37 and 35 %, respectively) but exceeds that in subjects with normal LV geometry (20 %). Associated and concomitant pathology determine the total and cardiovascular prognosis more in patients with concentric LVH than in subjects with eccentric LVH. The presence of ECG valid quantitative and strain diagnostic LVH criteria (Sokolow-Lyon index and Perugian university sign) determines the worst remote prognosis in patients with both concentric and eccentric LVH. The enlarged size of the left atrium is an universal marker of poor outcome in hypertensive patients regardless the type оf left ventricular geometry.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients With Aortic Stenosis

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. Clinical Trial Registration— http://www.clinicaltrials.gov . Unique identifier: NCT00092677.

Racial Differences in Incident Heart Failure During Antihypertensive Therapy

Blacks have a higher prevalence of heart failure (HF) than nonblacks, possibly reflecting a greater burden of HF risk factors, including hypertension. Although HF incidence is significantly higher in blacks during long-term follow-up of young adults, the relationship of incident HF to race in hypertensive patients undergoing treatment is unclear. Incident HF was evaluated in 497 black and 8199 nonblack hypertensive patients with no history of HF randomly assigned to losartan- or atenolol-based treatment. During 4.7±1.1 years mean follow-up, HF hospitalization occurred in 265 patients (3.0%); 5-year HF incidence was significantly greater in black than nonblack patients (7.0 versus 3.1%, P<0.001). In Cox multivariate analyses adjusting for randomized treatment, age, sex, the presence of the strain pattern on the baseline ECG, and other HF risk factors treated as standard covariates, and for incident myocardial infarction, in-treatment QRS duration, diastolic and systolic pressure, Cornell product, and Sokolow-Lyon voltage criteria for left ventricular hypertrophy (LVH) treated as time-varying covariates, black race remained associated with a 130% increased risk of developing new HF (hazard ratio 2.30, 95% confidence interval 1.24 to 4.28). Incident HF is substantially more common among black than nonblack hypertensive patients. The increased risk of developing new HF in blacks persists after adjusting for the higher prevalence of HF risk factors in blacks, for treatment effects and in-treatment blood pressure, and for the known predictive value of the ECG strain pattern and in-treatment ECG LVH and QRS duration for incident HF in this population. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00338260.

A Tissue-Level Electromechanical Model of the Left Ventricle: Application to the Analysis of Intraventricular Pressure

The ventricular pressure profile is characteristic of the cardiac contraction progress and is useful to evaluate the cardiac performance. In this contribution, a tissue-level electromechanical model of the left ventricle is proposed, to assist the interpretation of left ventricular pressure waveforms. The left ventricle has been modeled as an ellipsoid composed of twelve mechano-hydraulic sub-systems. The asynchronous contraction of these twelve myocardial segments has been represented in order to reproduce a realistic pressure profiles. To take into account the different energy domains involved, the tissue-level scale and to facilitate the building of a modular model, multiple formalisms have been used: Bond Graph formalism for the mechano-hydraulic aspects and cellular automata for the electrical activation. An experimental protocol has been defined to acquire ventricular pressure signals from three pigs, with different afterload conditions. Evolutionary Algorithms have been used to identify the model parameters in order to minimize the error between experimental and simulated ventricular pressure signals. Simulation results show that the model is able to reproduce experimental ventricular pressure. In addition, electro-mechanical activation times have been determined in the identification process. For example, the maximum electrical activation time is reached, respectively, 96.5, 139.3 and 131.5 ms for the first, second, and third pigs. These preliminary results are encouraging for the application of the model on non-invasive data like ECG, arterial pressure or myocardial strain.

ECG strain predicts cardiovascular risk

ECG strain predicts cardiovascular risk

Prognostic Value of Changes in the Electrocardiographic Strain Pattern During Antihypertensive Treatment

The presence of the ECG strain pattern of lateral ST depression and T-wave inversion at baseline has been associated with an increased risk of cardiovascular morbidity and mortality; however, the independent predictive value for cardiovascular outcomes of regression versus persistence versus development of new ECG strain during antihypertensive therapy is unclear. ECG strain was evaluated at baseline and after 1 year of therapy in 7409 hypertensive patients in the LIFE study (Losartan Intervention For End-point reduction in hypertension) treated in a blinded manner with atenolol- or losartan-based regimens. During 3.8+/-0.8 years of follow-up after the year 1 ECG, cardiovascular death occurred in 236 patients (3.2%), myocardial infarction in 198 (2.7%), stroke in 313 (4.2%), the LIFE composite end point of these 3 events in 600 (8.1%), sudden death in 92 (1.2%), and death due to any cause in 486 (6.6%). Strain was absent on both baseline and year 1 ECGs in 6323 patients (85.3%), regressed from baseline to year 1 in 245 (3.3%), persisted on both ECGs in 549 (7.4%), and was absent at baseline but developed by year 1 in 292 patients (3.9%). Compared with absence of strain on both ECGs, development of new ECG strain was associated with 2.8- to 4.7-fold higher event rates; patients with regression or persistence of strain had intermediate event rates. In Cox multivariable analyses with adjustment for the known predictive value of in-treatment ECG left ventricular hypertrophy by Cornell product and Sokolow-Lyon voltage, in-treatment systolic and diastolic pressure, randomized treatment, and standard cardiovascular risk factors, development of new ECG strain was independently associated with increased risks of cardiovascular death (hazard ratio [HR] 2.42, 95% confidence interval [CI] 1.56 to 3.76), myocardial infarction (HR 1.95, 95% CI 1.11 to 3.44), stroke (HR 1.98, 95% CI 1.30 to 3.01), the LIFE composite end point (HR 2.05, 95% CI 1.51 to 2.78), sudden cardiac death (HR 2.19, 95% CI 1.06 to 4.53), and all-cause mortality (HR 1.92, 95% CI 1.37 to 2.69), whereas the risk associated with regression or persistence of strain was attenuated. Development of new ECG strain is associated with an increased risk of cardiovascular morbidity and mortality and of all-cause mortality in the setting of antihypertensive therapy and regression of ECG left ventricular hypertrophy.