title: Strain Pattern on Electrocardiogram Is Associated with Increased Carotid Intima-Media Thickness in Patients with Aortic Valve Stenosis.
abstract: BACKGROUND
  Coronary artery disease is present in at least 30% of patients with degenerative aortic stenosis (AS). Atherosclerosis also performs an important role in the progression of AS, because of the similarities of pathological mechanisms in both conditions. The electrocardiogram (EKG) strain pattern is associated with structural myocardial change and subendocardial ischemia and has been worldwide used as a marker of AS severity. We hypothesized that EKG strain pattern would be a marker of atherosclerosis as well in AS patients. The aim of this study was to associate the presence of EKG strain pattern in AS patients with the carotid intima-media thickness (CIMT).
  
  
  METHODS
  Fifty-two consecutive patients referred from the cardiology clinic with moderate or severe AS were included in the study and underwent clinical evaluation, EKG, transthoracic echocardiography, and carotid ultrasonography, following statistical analysis of the results.
  
  
  RESULTS
  There was a significant association between left ventricular EKG strain and increased CIMT (P = 0.001). The presence of strain increased the odds of abnormal CIMT (P = 0.004, odds ratio 9.7, 95% confidence interval 2.4-45.0), in a model adjusted for age and clinical diagnosis of systemic arterial hypertension. Additionally, EKG strain was associated with the presence of atherosclerotic plaque in at least one carotid artery (P = 0.011).
  
  
  CONCLUSIONS
  Our results suggest that AS patients with EKG strain pattern should be further investigated for the diagnosis of subclinical atherosclerotic disease.
authors.affiliation: Medicine Department, Cardiology Division, São Carlos Federal University -UFSCar, São Carlos, Brazil. Electronic address: meliza10@hotmail.com.
authors.forename: Meliza Goi
authors.initials: MG
authors.lastname: Roscani
authors.affiliation: Botucatu Medical School, Medicine Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Gustavo N
authors.initials: GN
authors.lastname: Augusto
authors.affiliation: Botucatu Medical School, Medicine Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Tainá F C
authors.initials: TF
authors.lastname: Valadão
authors.affiliation: Botucatu Medical School, Medicine Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Jonas A
authors.initials: JA
authors.lastname: Araújo
authors.affiliation: Botucatu Medical School, Medicine Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Juliana C
authors.initials: JC
authors.lastname: Duarte
authors.affiliation: Biosciences Institute of Botucatu, Physiology Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Juliana I F
authors.initials: JI
authors.lastname: Gobbi
authors.affiliation: Biosciences Institute of Botucatu, Statistical Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Liciana V A
authors.initials: LV
authors.lastname: Silveira
authors.affiliation: Botucatu Medical School, Medicine Department, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Regina C
authors.initials: RC
authors.lastname: Coneglian
authors.affiliation: Internal Medicine Department, Cardiology Division, Botucatu Medical School, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Daniele A
authors.initials: DA
authors.lastname: Rossi
authors.affiliation: Internal Medicine Department, Cardiology Division, Botucatu Medical School, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Silméia G
authors.initials: SG
authors.lastname: Zanati
authors.affiliation: Internal Medicine Department, Cardiology Division, Botucatu Medical School, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: Beatriz B
authors.initials: BB
authors.lastname: Matsubara
authors.affiliation: Internal Medicine Department, Cardiology Division, Botucatu Medical School, Universidade Estadual Paulista - UNESP, São Paulo, Brazil.
authors.forename: João C
authors.initials: JC
authors.lastname: Hueb
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D058070:Asymptomatic Diseases; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002340:Carotid Artery Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D016009:Chi-Square Distribution; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012815:Signal Processing, Computer-Assisted; D013314:Stress, Mechanical; D016277:Ventricular Function, Left