{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:07:39Z","timestamp":1791439659037,"version":"4.3.3"},"reference-count":18,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2012,1,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background\u2014<\/jats:title>\n                    <jats:p>The prognostic impact of ECG left ventricular strain and left ventricular hypertrophy (LVH) in asymptomatic aortic stenosis is not well described.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results\u2014<\/jats:title>\n                    <jats:p>\n                      Data were obtained in asymptomatic patients randomized to simvastatin\/ezetimibe combination versus placebo in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Primary end point was the first of myocardial infarction, nonhemorrhagic stroke, heart failure, aortic valve replacement, or cardiovascular death. The predictive value of ECG left ventricular strain (defined as T-wave inversion in leads V\n                      <jats:sub>4<\/jats:sub>\n                      through V\n                      <jats:sub>6<\/jats:sub>\n                      ) and LVH, assessed by Sokolow-Lyon voltage criteria (R\n                      <jats:sub>V5\u20136<\/jats:sub>\n                      +S\n                      <jats:sub>V1<\/jats:sub>\n                      \u226535 mV) and Cornell voltage-duration criteria {[RaVL+S\n                      <jats:sub>V3<\/jats:sub>\n                      +(6 mV in women)]\u00d7QRS duration \u22652440 mV \u00b7 ms}, was evaluated by adjustment for other prognostic covariates. A total of 1533 patients were followed for 4.3\u00b10.8 years (6592 patient-years of follow-up), and 627 cardiovascular events occurred. ECG strain was present in 340 patients (23.6%), with LVH by Sokolow-Lyon voltage in 260 (17.1%) and by Cornell voltage-duration product in 220 (14.6%). In multivariable analyses, ECG left ventricular strain was associated with 3.1-fold higher risk of in-study myocardial infarction (95% confidence interval, 1.4\u20136.8;\n                      <jats:italic>P<\/jats:italic>\n                      =0.004). Similarly, ECG LVH by both criteria predicted, compared with no ECG LVH, 5.8-fold higher risk of heart failure (95% confidence interval, 2.0\u201316.8), 2.0-fold higher risk of aortic valve replacement (95% confidence interval, 1.3\u20133.1; both\n                      <jats:italic>P<\/jats:italic>\n                      =0.001), and 2.5-fold higher risk of a combined end point of myocardial infarction, heart failure, or cardiovascular death (95% confidence interval, 1.3\u20134.9;\n                      <jats:italic>P<\/jats:italic>\n                      =0.008).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>ECG left ventricular strain and LVH were independently predictive of poor prognosis in patients with asymptomatic aortic stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration\u2014<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov.\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      . Unique identifier: NCT00092677.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.111.049759","type":"journal-article","created":{"date-parts":[[2011,12,7]],"date-time":"2011-12-07T00:38:49Z","timestamp":1323218329000},"page":"346-353","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":68,"title":["Clinical Implications of Electrocardiographic Left Ventricular Strain and Hypertrophy in Asymptomatic Patients With Aortic Stenosis"],"prefix":"10.1161","volume":"125","author":[{"given":"Anders M.","family":"Greve","sequence":"first","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Boman","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christa","family":"Gohlke-Baerwolf","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y. Antero","family":"Kes\u00e4niemi","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Nienaber","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Ray","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Egstrup","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne B.","family":"Rosseb\u00f8","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard B.","family":"Devereux","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronnie","family":"Willenheimer","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Wachtell","sequence":"additional","affiliation":[{"name":"From the Department of Medicine B, The Heart Center, Rigshospitalet, Copenhagen, Denmark (A.M.G., L.K., K.W.); Department of Medicine, Institution of Public Health and Clinical Medicine, Ume\u00e5 University, Skelleft\u00e5, Sweden (K.B.); Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany (C.G.-B.); Institute of Clinical Medicine, Department of Internal Medicine and Biocenter Oulu, University of Oulu and Clinical Research Center, Oulu University Hospital, Oulu, Finland (Y.A.K.); Department of Cardiology and..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-2007-1012039"},{"key":"e_1_3_3_3_2","first-page":"182","article-title":"Influence of atypical symptoms and electrocardiographic signs of left ventricular hypertrophy or ST-segment\/T-wave abnormalities on the natural history of otherwise asymptomatic adults with moderate to severe aortic stenosis: preliminary communication","volume":"13","author":"Hering D","year":"2004","unstructured":"Hering D, Piper C, Horstkotte D. Influence of atypical symptoms and electrocardiographic signs of left ventricular hypertrophy or ST-segment\/T-wave abnormalities on the natural history of otherwise asymptomatic adults with moderate to severe aortic stenosis: preliminary communication. J Heart Valve Dis. 2004; 13: 182\u2013187.","journal-title":"J Heart Valve Dis"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.38.1S5.V-61"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0804602"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2006.10.064"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.03.084"},{"key":"e_1_3_3_8_2","first-page":"298","volume-title":"The Minnesota Code Manual of Electrocardiographic Findings","author":"Prineas RJ","year":"1982","unstructured":"Prineas RJ, Crowe RS, Blackburn H. The Minnesota Code Manual of Electrocardiographic Findings. Bristol, UK: John Wright; 1982: 298."},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2008.12.021"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejechocard\/jen303"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2005.10.005"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_3_3_13_2","first-page":"A0828","article-title":"A simplified equation to predict glomerular filtration rate from serum creatinine","volume":"11","author":"Levey AS","year":"2000","unstructured":"Levey AS, Greene T, Kusek JW, Beck GL. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000; 11: A0828.","journal-title":"J Am Soc Nephrol"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.1.48"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(92)90360-Y"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.58.1.38"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(99)00499-4"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.4.892"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1681.1999.03165.x"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.111.049759","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:08:42Z","timestamp":1715566122000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.111.049759"}},"subtitle":["The Simvastatin and Ezetimibe in Aortic Stenosis Study"],"short-title":[],"issued":{"date-parts":[[2012,1,17]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2012,1,17]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.111.049759"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.111.049759","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.13997960.15453091","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,1,17]]},"assertion":[{"value":"2011-06-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2011-11-24","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2011-12-06","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}