Serial assessment of the electrocardiographic strain pattern for prediction of new-onset heart failure during antihypertensive treatment: the LIFE study

Aims Although the presence of the electrocardiographic (ECG) strain pattern has been associated with an increased risk of developing heart failure (HF), the relationship of regression vs. persistence vs. development of new ECG strain to subsequent HF is unclear. Methods and results Electrocardiographic strain was evaluated at baseline and at year-1 in 7265 hypertensive patients without HF treated with atenolol- or losartan-based regimens. During 3.9 +/- 0.7 years of follow-up after the year-1 ECG, 154 patients (2.1%) were hospitalized for HF. Five-year HF incidence was lowest in patients with no ECG strain (1.6%), intermediate in patients with regression of strain (5.4%), and highest in patients with persistent (7.1%) or new strain (7.0%; P < 0.0001 across groups). In the Cox multivariable analyses adjusting for the known predictive value of in-treatment ECG left ventricular hypertrophy by the Cornell product and Sokolow-Lyon voltage, in-treatment QRS duration, systolic and diastolic pressure, incident myocardial infarction and atrial fibrillation, randomized treatment and other risk factors for HF, regression of strain [hazards ratio (HR) 2.4, 95% confidence interval (CI) 1.2-5.0], persistence of strain (HR 1.9, 95% CI 1.2-3.2), and development of new ECG strain (HR 2.3, 95% CI 1.2-4.4) were all independently associated with an increased risk of new HF compared with the absence of ECG strain on both baseline and year-1 ECGs. Conclusion The development of new ECG strain or persistence of ECG strain between baseline and year-1 is associated with an increased risk of HF. The regression of ECG strain between baseline and year-1 does not convey a decreased risk of HF. Clinical trials registration: http://clinicaltrials.gov/ct/show/NCT00338260.