Prognostic significance of preoperative ECG Strain after Transcatheter Aortic Valve Replacement for severe Aortic Stenosis

Introduction Electrocardiographic (ECG) Strain, a marker of severity in aortic stenosis and myocardial fibrosis is associated with major cardiovascular events in aortic stenosis (AS) and after surgical aortic valve replacement. Objective We aimed at investigating the clinical significance of preoperative ECG Strain after Transcatheter Aortic Valve Replacement (TAVR). Method Between April 2008 and December 2015, we prospectively included consecutive patients referred to our Heart Valve Clinic for a first TAVR for severe AS. ECG Strain was defined as a ≥ 1 mm concave downslopping ST-segment depression with T inversion in V5–V6 on preoperatory ECG. Patients were followed for major events (ME), i.e. cardiovascular death, cardiac hospitalization for acute heart failure and stroke. Results 228 patients were included with a median follow up period of 2.9 years. The middle age was 80.3 years, 40.4% were men and for the most part with hypertension (72.4%). 73 patients had ECG Strain (32%). The ECG strain was independently associated with a more important dyspnea, according to the NYHA classification (1.68 [1.02–2.76] P  = 0.04) and a significantly higher left ventricular mass in echocardiography (0.01 ± 0.006 P  = 0.04). Finally, ECG Strain was significantly associated with increased occurrence of ME (46.6% vs 36.13% P  = 0.05) but not with cardiovascular or all-cause deaths (respectively P  = 0.90 and P  = 0.32) ( Fig. 1 ). Conclusion Preoperative ECG Strain was associated with higher risk of ME onset after TAVR for severe AS.