title: Usefulness of the electrocardiogram in predicting cardiovascular mortality in asymptomatic adults with aortic stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis Study).
abstract: Hypertension and coronary heart disease are common in aortic stenosis (AS) and may impair prognosis for similar AS severity. Different changes in the electrocardiogram may be reflective of the separate impacts of AS, hypertension, and coronary heart disease, which could lead to enhanced risk stratification in AS. The aim of this study was therefore to examine if combining prognostically relevant electrocardiographic (ECG) findings improves prediction of cardiovascular mortality in asymptomatic AS. All patients with baseline electrocardiograms in the SEAS study were included. The primary end point was cardiovascular death. Backward elimination (p >0.01) identified heart rate, Q waves, and Cornell voltage-duration product as independently associated with cardiovascular death. Multivariate logistic and Cox regression models were used to evaluate if these 3 ECG variables improved prediction of cardiovascular death. In 1,473 patients followed for a mean of 4.3 years (6,362 patient-years of follow-up), 70 cardiovascular deaths (5%) occurred. In multivariate analysis, heart rate (hazard ratio [HR] 1.5 per 11.2 minute(-1) [1 SD], 95% confidence interval [CI] 1.2 to 1.8), sum of Q-wave amplitude (HR 1.3 per 2.0 mm [1 SD], 95% CI 1.1 to 1.6), and Cornell voltage-duration product (HR 1.4 per 763 mm × ms [1 SD], 95% CI 1.2 to 1.7) remained independently associated with cardiovascular death. Combining the prognostic information contained in each of the 3 ECG variables improved integrated discrimination for prediction of cardiovascular death by 2.5%, net reclassification by 14.3%, and area under the curve by 0.06 (all p ≤0.04) beyond other important risk factors. ECG findings add incremental predictive information for cardiovascular mortality in asymptomatic patients with AS.
authors.affiliation: Department of Medicine B2142, The Heart Center, Rigshospitalet, Copenhagen, Denmark. Electronic address: greve_anders@outlook.com.
authors.forename: Anders M
authors.initials: AM
authors.lastname: Greve
authors.affiliation: Department of Medicine B2142, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Dalsgaard
authors.affiliation: Department of Medicine B2142, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Casper N
authors.initials: CN
authors.lastname: Bang
authors.affiliation: Kardiologisk Afdeling, OUH Svendborg Sygehus, Odense, Denmark.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
authors.affiliation: Department of Cardiology, Oslo University Hospital, Ullevål, Oslo, Norway.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Rossebø
authors.affiliation: Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden.
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.affiliation: Department of Cardiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.affiliation: Department of Cardiology and Angiology, University Heart Center Rostock, Rostock School of Medicine, Rostock, Germany.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Department of Cardiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Baerwolf
authors.affiliation: Department of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: Department of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Department of Medicine B2142, The Heart Center, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Medicine B2142, The Heart Center, Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Glostrup University Hospital, Copenhagen, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D001384:Azetidines / Q000627:therapeutic use*; D002423:Cause of Death / Q000639:trends; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000706:statistics & numerical data*; D000069438:Ezetimibe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D019821:Simvastatin / Q000627:therapeutic use*; D015996:Survival Rate / Q000639:trends
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019821:Simvastatin; D000069438:Ezetimibe