title: Electrocardiographic strain pattern and prediction of cardiovascular morbidity and mortality in hypertensive patients.
abstract: The ECG strain pattern of lateral ST depression and T-wave inversion is a marker for left ventricular hypertrophy (LVH) and adverse prognosis in population studies. However, whether ECG strain is an independent predictor of cardiovascular (CV) morbidity and mortality in the setting of aggressive antihypertensive therapy is unclear. ECGs were examined at study baseline in 8854 hypertensive patients with ECG LVH who were treated in a blinded manner with atenolol- or losartan-based regimens. Strain was defined by the presence of a downsloping convex ST segment with an inverted asymmetrical T wave opposite to the QRS axis in leads V5 and/or V6 and was present in 971 patients (11.0%). The Losartan Intervention For Endpoint reduction in hypertension (LIFE) study composite end point of CV death or nonfatal myocardial infarction or stroke occurred in 1035 patients (11.7%). In Cox analyses adjusting only for treatment effect, ECG strain was a significant predictor of CV death (hazard ratio [HR] 2.26, 95% confidence interval [CI] 1.78 to 2.86), fatal/nonfatal myocardial infarction (HR 2.16, 95% CI 1.67 to 2.80), fatal/nonfatal stroke (HR 1.76, 95% CI 1.39 to 2.21), and the composite CV end point (HR 1.99, 95% CI 1.70 to 2.33). After further adjusting for standard CV risk factors, baseline blood pressure, and severity of ECG LVH, ECG strain remained a significant predictor of CV mortality (HR 1.53, 95% CI 1.18 to 2.00), myocardial infarction (HR 1.55, 95% CI 1.16 to 2.06), and the composite CV end point (HR 1.33, 95% CI 1.11 to 1.59). Thus, ECG strain is a marker of increased CV risk in hypertensive patients in the setting of aggressive blood pressure lowering, independent of baseline severity of ECG LVH.
authors.affiliation: Greenberg Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th St, New York, NY 10021, USA. pokin@mail.med.cornell.edu
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Sverker
authors.initials: S
authors.lastname: Jern
authors.forename: Lasse
authors.initials: L
authors.lastname: Oikarinen
authors.forename: Matti
authors.initials: M
authors.lastname: Viitasalo
authors.forename: Lauri
authors.initials: L
authors.lastname: Toivonen
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Steven
authors.initials: S
authors.lastname: Snapinn
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001262:Atenolol / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D017379:Hypertrophy, Left Ventricular / Q000150:complications*; D019808:Losartan / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis
chemical_list: D000959:Antihypertensive Agents; D001262:Atenolol; D019808:Losartan