Gard Mikael Saele Myrmel, Daanyaal Wasim, Ronak Rajani, Denise Parkin, John B Chambers, Sahrai Saeed
{"title":"无症状中重度主动脉瓣狭窄患者运动平板试验时心电图ST段压低的临床意义及预后价值","authors":"Gard Mikael Saele Myrmel, Daanyaal Wasim, Ronak Rajani, Denise Parkin, John B Chambers, Sahrai Saeed","doi":"10.1080/14017431.2022.2095437","DOIUrl":null,"url":null,"abstract":"<p><p><i>Objectives.</i> In patients with asymptomatic moderate or severe aortic stenosis (AS), exercise testing is used for evaluating the need for aortic valve intervention. Expert opinions about the clinical significance and prognostic value of ST segment depression on electrocardiography (ECG) during exercise testing in AS is conflicting and there are no large studies exploring this issue. We aimed to explore the association of ST segment depression >5 mm during exercise treadmill test (ETT) with all-cause mortality, aortic valve replacement (AVR) or cardiac-related hospitalization. <i>Design.</i> We performed a retrospective analysis of prospectively collected data of a total of 315 patients (mean age 65 ± 12 years, 67% men) with asymptomatic moderate (<i>n</i> = 209; 66%) or severe (<i>n</i> = 106; 34%) AS. All patients underwent clinical evaluation, echocardiography and ETT. <i>Results.</i> During a mean follow-up of 34.9 ± 34.6 months, 29 (9%) patients died and 235 (74%) underwent AVR. The prevalence of ST segment depression (>5 mm) was 13% (<i>n</i> = 41) in the total study population and was comparable in patients with revealed symptoms (17.6%, <i>n</i> = 16) versus without revealed symptoms (11.3%, <i>n</i> = 25; <i>p</i> = .132). ST segment depression on ETT was strongly associated with aortic valve area. In univariate Cox regression analysis, ST segment depression was not associated with cardiac related hospitalizations (HR 1.65; 95% CI 0.89-3.10, <i>p</i> = .113), all-cause mortality (HR 1.37; 95% CI 0.47-3.98, <i>p</i> = .564) or AVR (HR 1.30; 95% CI 0.89-1.91, <i>p</i> = .170). <i>Conclusion.</i> In patients with moderate or severe AS, ST segment depression during ETT is non-specific, carries no prognostic risk and should be used with caution in the clinical interpretation of exercise test.</p>","PeriodicalId":21383,"journal":{"name":"Scandinavian Cardiovascular Journal","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Clinical significance and prognostic value of ST segment depression on ECG during exercise treadmill test in asymptomatic patients with moderate or severe aortic stenosis.\",\"authors\":\"Gard Mikael Saele Myrmel, Daanyaal Wasim, Ronak Rajani, Denise Parkin, John B Chambers, Sahrai Saeed\",\"doi\":\"10.1080/14017431.2022.2095437\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><i>Objectives.</i> In patients with asymptomatic moderate or severe aortic stenosis (AS), exercise testing is used for evaluating the need for aortic valve intervention. Expert opinions about the clinical significance and prognostic value of ST segment depression on electrocardiography (ECG) during exercise testing in AS is conflicting and there are no large studies exploring this issue. We aimed to explore the association of ST segment depression >5 mm during exercise treadmill test (ETT) with all-cause mortality, aortic valve replacement (AVR) or cardiac-related hospitalization. <i>Design.</i> We performed a retrospective analysis of prospectively collected data of a total of 315 patients (mean age 65 ± 12 years, 67% men) with asymptomatic moderate (<i>n</i> = 209; 66%) or severe (<i>n</i> = 106; 34%) AS. All patients underwent clinical evaluation, echocardiography and ETT. <i>Results.</i> During a mean follow-up of 34.9 ± 34.6 months, 29 (9%) patients died and 235 (74%) underwent AVR. The prevalence of ST segment depression (>5 mm) was 13% (<i>n</i> = 41) in the total study population and was comparable in patients with revealed symptoms (17.6%, <i>n</i> = 16) versus without revealed symptoms (11.3%, <i>n</i> = 25; <i>p</i> = .132). ST segment depression on ETT was strongly associated with aortic valve area. In univariate Cox regression analysis, ST segment depression was not associated with cardiac related hospitalizations (HR 1.65; 95% CI 0.89-3.10, <i>p</i> = .113), all-cause mortality (HR 1.37; 95% CI 0.47-3.98, <i>p</i> = .564) or AVR (HR 1.30; 95% CI 0.89-1.91, <i>p</i> = .170). <i>Conclusion.</i> In patients with moderate or severe AS, ST segment depression during ETT is non-specific, carries no prognostic risk and should be used with caution in the clinical interpretation of exercise test.</p>\",\"PeriodicalId\":21383,\"journal\":{\"name\":\"Scandinavian Cardiovascular Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Scandinavian Cardiovascular Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1080/14017431.2022.2095437\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Scandinavian Cardiovascular Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/14017431.2022.2095437","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 1
摘要
目标。对于无症状的中度或重度主动脉瓣狭窄(AS)患者,运动试验用于评估是否需要主动脉瓣介入治疗。专家们对AS运动试验时心电图ST段压低的临床意义和预后价值的看法是相互矛盾的,目前还没有大规模的研究来探讨这一问题。我们的目的是探讨运动平板试验(ETT)中ST段下陷> 5mm与全因死亡率、主动脉瓣置换术(AVR)或心脏相关住院的关系。设计。我们对315例无症状中度患者(n = 209;66%)或严重(n = 106;34%)。所有患者均接受了临床评估、超声心动图和ETT检查。结果。在平均34.9±34.6个月的随访中,29例(9%)患者死亡,235例(74%)患者行AVR。ST段凹陷(> 5mm)的患病率在整个研究人群中为13% (n = 41),在有明显症状的患者(17.6%,n = 16)和无明显症状的患者(11.3%,n = 25;p = .132)。ETT的ST段下陷与主动脉瓣面积密切相关。在单因素Cox回归分析中,ST段凹陷与心脏相关住院无关(HR 1.65;95% CI 0.89-3.10, p = 0.113),全因死亡率(HR 1.37;95% CI 0.47-3.98, p = .564)或AVR (HR 1.30;95% CI 0.89-1.91, p = 0.170)。结论。在中度或重度AS患者中,ETT期间ST段下降是非特异性的,没有预后风险,在临床解释运动试验时应谨慎使用。
Clinical significance and prognostic value of ST segment depression on ECG during exercise treadmill test in asymptomatic patients with moderate or severe aortic stenosis.
Objectives. In patients with asymptomatic moderate or severe aortic stenosis (AS), exercise testing is used for evaluating the need for aortic valve intervention. Expert opinions about the clinical significance and prognostic value of ST segment depression on electrocardiography (ECG) during exercise testing in AS is conflicting and there are no large studies exploring this issue. We aimed to explore the association of ST segment depression >5 mm during exercise treadmill test (ETT) with all-cause mortality, aortic valve replacement (AVR) or cardiac-related hospitalization. Design. We performed a retrospective analysis of prospectively collected data of a total of 315 patients (mean age 65 ± 12 years, 67% men) with asymptomatic moderate (n = 209; 66%) or severe (n = 106; 34%) AS. All patients underwent clinical evaluation, echocardiography and ETT. Results. During a mean follow-up of 34.9 ± 34.6 months, 29 (9%) patients died and 235 (74%) underwent AVR. The prevalence of ST segment depression (>5 mm) was 13% (n = 41) in the total study population and was comparable in patients with revealed symptoms (17.6%, n = 16) versus without revealed symptoms (11.3%, n = 25; p = .132). ST segment depression on ETT was strongly associated with aortic valve area. In univariate Cox regression analysis, ST segment depression was not associated with cardiac related hospitalizations (HR 1.65; 95% CI 0.89-3.10, p = .113), all-cause mortality (HR 1.37; 95% CI 0.47-3.98, p = .564) or AVR (HR 1.30; 95% CI 0.89-1.91, p = .170). Conclusion. In patients with moderate or severe AS, ST segment depression during ETT is non-specific, carries no prognostic risk and should be used with caution in the clinical interpretation of exercise test.
期刊介绍:
The principal aim of Scandinavian Cardiovascular Journal is to promote cardiovascular research that crosses the borders between disciplines. The journal is a forum for the entire field of cardiovascular research, basic and clinical including:
• Cardiology - Interventional and non-invasive
• Cardiovascular epidemiology
• Cardiovascular anaesthesia and intensive care
• Cardiovascular surgery
• Cardiovascular radiology
• Clinical physiology
• Transplantation of thoracic organs