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. 2023 Aug 27;12(17):5588.
doi: 10.3390/jcm12175588.

Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis

Giedrė Balčiūnaitė  1 , Ieva Rudinskaitė  2 , Darius Palionis  3 , Justinas Besusparis  4 , Edvardas Žurauskas  4 , Vilius Janušauskas  1 , Aleksejus Zorinas  1 , Nomeda Valevičienė  3 , Kęstutis Ručinskas  1 , Peter Sogaard  1   5 , Sigita Glaveckaitė  1
Affiliations

Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis

Giedrė Balčiūnaitė et al. J Clin Med. .

Abstract

The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain in relation to LV remodeling and myocardial fibrosis. 83 severe AS patients underwent surgical AVR, with preoperative 12-lead ECG, cardiovascular magnetic resonance with T1 mapping and echocardiography with global longitudinal strain analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies sampled during AVR. Patients with ECG strain had more severe AS, more advanced LV remodeling and evidence of heart failure. Patients with ECG strain had more diffuse fibrosis, as evident by higher mean native T1 values (974.8 ± 34 ms vs. 946.5 ± 28 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46-34.48, p = 0.02). Patients with persistent ECG strain at 1 year following AVR had more advanced LV remodeling and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Therefore, ECG strain is a marker of adverse LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.

Keywords: T1 mapping; aortic stenosis; cardiovascular magnetic resonance; electrocardiographic strain; myocardial fibrosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
FIB-AS study flow chart.
Figure 2
Figure 2
Illustrative comparison of cardiovascular imaging and histology data of two exemplar patients: electrocardiography (Column 1), global longitudinal strain (GLS; Column 2), matching native T1 (Column 3), and collagen volume fraction (CVF) in myocardial biopsies stained with Masson’s trichrome (Column 4). Patient without ECG changes (A) has preserved GLS, low native T1, and low histological fibrosis (CVF of 1.3%), whereas patient with ECG strain (B) has significantly reduced GLS, high native T1, and extensive histological fibrosis (CVF 23.5%).
Figure 3
Figure 3
Correlations between QRS voltage and native T1 (a), LV ejection fraction (LVEF) (b), QRS duration and LV diastolic diameter (CMR) (c), and LV mass (CMR) (d).
Figure 4
Figure 4
The graph shows a comparison of histological myocardial fibrosis between the patient’s group with and without ECG strain at 1 year following aortic valve replacement. A higher proportion of collagen volume fraction (CVF) at baseline assessment was detected in patients with persistent ECG strain compared to patients with no evidence of ECG strain.
See this image and copyright information in PMC

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