title: Prognostic Significance of ST-Segment Elevation in Leads V₁-₂ in Patients With Severe Aortic Stenosis.
abstract: BACKGROUND
  ST-segment elevation (STE) in leads V1-2 is often observed in patients with severe aortic stenosis (AS), but its significance remains unknown.
  
  
  RESULTS
  We retrospectively evaluated baseline ECGs and 5-year clinical outcomes in 211 consecutive patients with severe AS, defined as peak aortic jet velocity (Aortic Vmax) >4.0 m/s, or mean aortic pressure gradient >40 mmHg, or aortic valve area (AVA) <1.0 cm(2). The primary outcome measure was a composite of death or surgical aortic valve replacement (AVR). Patients with STE in leads V1-2(≥0.15 mV) had greater Aortic Vmax and smaller AVA than patients without. With a median follow-up of 4.9 years, the cumulative 5-year incidence of death or AVR was significantly higher in patients with STE in leads V1-2 than in patients without (91.4% vs. 77.1%; P=0.003). After adjusting for confounders, STE in leads V1-2 was independently associated with higher risk for death or AVR (hazard ratio, 1.53; 95% confidence interval, 1.06-2.22; P=0.02). In 64 asymptomatic patients without any indication for AVR at initial diagnosis of severe AS, the cumulative incidence of AVR was significantly higher in patients with STE in leads V1-2 than in patients without (57.6% vs. 30.5%; P<0.001).
  
  
  CONCLUSIONS
  STE in leads V1-2 independently predicted poorer prognosis and more frequent need for AVR in patients with severe AS.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Taniguchi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakatsuma
authors.forename: Masataka
authors.initials: M
authors.lastname: Nishiga
authors.forename: Tomoki
authors.initials: T
authors.lastname: Sasa
authors.forename: Naritatsu
authors.initials: N
authors.lastname: Saito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000503:physiopathology*; D001794:Blood Pressure; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index