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Prognostic significance of baseline and serial changes in electrocardiographic strain pattern in resistant

Gil F Salles1, Claudia Rl Cardoso, Roberto Fiszman

  • 1Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. gilsalles@hucff.ufrj.br

Journal of Hypertension
|June 4, 2010
PubMed

Insights

Changes in electrocardiographic strain pattern predict cardiovascular events and mortality in resistant hypertension patients. Preventing or reversing strain may improve outcomes in this high-risk group.

Area of Science:

  • Cardiology
  • Clinical Electrophysiology
  • Hypertension Research

Background:

  • Electrocardiographic (ECG) strain pattern, characterized by lateral ST-depression and T-wave inversion, is observed in some patients.
  • The prognostic significance of baseline and evolving ECG strain patterns in resistant hypertension is not well understood.

Purpose of the Study:

  • To investigate the predictive value of baseline and serial ECG strain patterns for cardiovascular morbidity and mortality in patients with resistant hypertension.
  • To assess whether changes in strain pattern over time impact cardiovascular outcomes.

Main Methods:

  • A cohort of 532 patients with resistant hypertension underwent serial ECG examinations to assess for strain patterns.
  • Clinical, laboratory, echocardiographic, and ambulatory blood pressure data were collected.
  • Cox regression analysis was used to evaluate the association between strain patterns and cardiovascular endpoints, including total events, mortality, stroke, and coronary heart disease.

Main Results:

  • At baseline, 21.6% of patients exhibited the strain pattern; during follow-up, 17 patients showed regression and 22 developed new patterns.
  • Over a median of 4.8 years, 69 deaths and 107 cardiovascular events occurred.
  • Persistence or development of strain pattern independently predicted a composite of cardiovascular events and mortality (HR 1.97), all-cause mortality (HR 1.99), and stroke (HR 3.09) after adjusting for risk factors and left ventricular hypertrophy.

Conclusions:

  • Serial changes in ECG strain pattern are significant predictors of cardiovascular morbidity and mortality in resistant hypertension.
  • Regression or prevention of ECG strain pattern during treatment may represent a valuable therapeutic target to improve patient prognosis.
  • Combining strain pattern assessment with left ventricular hypertrophy criteria enhances cardiovascular risk stratification.
Abstract

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