Electrocardiographic Pattern of Left Ventricular Hypertrophy with Strain and Survival in Calcific Aortic Valve Disease

Background: The prevalence of electrocardiographic (ECG) patterns of left ventricular (LV) hypertrophy and strain in calcific aortic valve disease has not been extensively evaluated. We sought to evaluate the prevalence of ECG-defined LV hypertrophy and strain in a large cohort of patients with various grades of calcific aortic valve disease and to correlate these ECG patterns with survival.

Methods: A total of 1,437 patients (mean age 66 ± 14 years, 62.6% men) with calcific aortic valve disease were evaluated. Demographic, clinical variables and presence of ECG patterns of LV hypertrophy and strain were collected and related to occurrence of all-cause mortality, correcting for aortic valve replacement during follow-up.

Results: Aortic sclerosis was diagnosed in 29% of patients, mild aortic stenosis (AS) in 13%, moderate AS in 30% and severe AS in 28%. Seventy-six patients showed ECG pattern of LV hypertrophy without strain whereas 227 showed ECG pattern of LV hypertrophy with strain. Patients with LV hypertrophy with strain pattern showed more frequently severe AS. During a mean follow-up of 7.2 ± 4.8 years (10,258 patient-years), 545 (37.9%) patients died. Compared to ECG without hypertrophy pattern, ECG strain pattern was independently associated with all-cause mortality (HR 1.36, 95% CI 1.08–1.72; p = 0.009), whereas LV hypertrophy pattern on ECG was not (HR 1.38, 95% CI 0.94–2.24; p = 0.094).

Conclusions: The ECG strain pattern reflects an advanced stage of the LV remodeling process in the natural history of calcific aortic valve disease and is independently associated with worse outcome.