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Published on: October 20, 2023
Left ventricular hypertrophy with strain and aortic stenosis.
Anoop S V Shah1, Calvin W L Chin2, Vassilis Vassiliou1
1From the British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK (A.S.V.S., C.W.L.C., M.D., T.C.K., S.S., A.C.W., N.A.B., N.L.M., D.E.N., M.R.D.); Department of Cardiovascular Medicine, National Heart Center Singapore, Singapore (C.W.L.C.); Royal Brompton Hospital, London, UK (V.V., S.K.P.); National Heart and Lung Institute, Imperial College, London, UK (V.V., S.K.P.); NHS Lothian, Edinburgh, UK (S.J.C., A.C.W., G.M., N.A.B., N.L.M., D.E.N., M.R.D.); Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, UK (S.S., D.E.N.); and Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK (V.Z.).
Electrocardiogram (ECG) left ventricular hypertrophy with strain indicates significant myocardial fibrosis in aortic stenosis patients. This finding predicts adverse outcomes, including aortic valve replacement or cardiovascular death.
Area of Science:
- Cardiology
- Medical Imaging
- Biomarkers
Background:
- ECG left ventricular hypertrophy with strain is linked to poor prognosis in aortic stenosis.
- Understanding the mechanisms and outcomes of ECG strain is crucial for patient management.
Purpose of the Study:
- To investigate the mechanisms underlying ECG strain in aortic stenosis.
- To determine the association between ECG strain and myocardial fibrosis.
- To assess the predictive value of ECG strain for adverse clinical outcomes.
Main Methods:
- Utilized ECG, echocardiography, and cardiovascular magnetic resonance (CMR) in a mechanism cohort (n=102).
- Assessed myocardial fibrosis using late gadolinium enhancement and T1 mapping.
- Validated findings in an external cohort (n=64) and analyzed outcomes in a long-term cohort (n=140).
Main Results:
- Patients with ECG strain exhibited more severe aortic stenosis, increased left ventricular mass, and higher levels of myocardial injury and diffuse fibrosis.
- ECG strain was strongly associated with midwall late gadolinium enhancement, a marker of replacement fibrosis.
- Late gadolinium enhancement independently predicted ECG strain, a finding confirmed in the validation cohort.
Conclusions:
- ECG strain is a specific indicator of midwall myocardial fibrosis in aortic stenosis.
- ECG strain independently predicts adverse clinical outcomes, including aortic valve replacement or cardiovascular death.
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