SPC365

Global Longitudinal Strain and Strain Rate as markers of Subclinical Systolic Dysfunction in Patients with Moderate Aortic Stenosis

Session: SESSÃO DE POSTERS 38 - ANÁLISE DE DEFORMAÇÃO MIOCÁRDICA
Speaker: Inês Rodrigues

Congress: CPC 2025
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type: Cartazes
FP Number: ---
Authors: Inês Arrobas Rodrigues; Rafael Teixeira; António Santos; António Gonçalves; Leonor Moura; Marta Almeida; André Lobo; Inês Neves; Marta Leite; Fábio Nunes; Francisco Sampaio; Ricardo Fontes-Carvalho

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Background</span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Aortic stenosis (AS) induces an adaptative ventricular remodelling leading to left ventricular (LV) hypertrophy </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">as a compensatory response to increased afterload. While this adaptation temporarily perserves normal ejection fraction (EF), significant myocardial dysfunction may already be developing. Once LVEF begins to decline, it may not recover even after aortic valve replacement (AVR). Therefore, identifying alternative markers to detect </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">subclinical dysfunction before EF deterioration is crucial to improving patient outcomes. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Aim</span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">To explore the role of baseline left ventricle global longitudinal strain (GLS) and strain rate (SR) as markers of subclinical LV dysfunction, predictors of LVEF decline, and their impact on survival of patients with moderate AS.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Patients with moderate AS and LVEF &ge;50% in at least 2 previous echocardiograms were retrospectively identified. Prosthetic and bicuspid valves were excluded. Baseline LV GLS and SR were used as covariates in cox regression models to predict the cumulative incidence of LVEF depression over 5 years and overall survival after multivariable adjustment including time-dependent AVR.</span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results</span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">A total of 574 patients were included (age 76 &plusmn;9 years; 51% female; median follow-up time of 8,97 years). The average baseline aortic peak velocity was 3,4 &plusmn;0.8 m/s, mean pressure gradient was 25 &plusmn;9mmHg, aortic valve area was 1,1 &plusmn;0.3 cm<sup>2</sup>, and LVEF 60 &plusmn;5%. The mean GLS was -17 &plusmn;7% and the peak systolic SR was 1,2 &plusmn;0,5/s. Both baseline GLS (HR=0.88 for each -1%; 95% CI = 0,79-0,99; p=0,04) and SR (HR=0,89 for each +0.1/s; 95% CI = 0,80-0,99; p=0,03) were associated with a 5-year incidence of LVEF depression (&lt;50%). Incorporating SR to GLS improved risk discrimination (increase in area under curve from 0,78 to 0,84; 95% CI = 0,01-0,10; p=0,04). Furthermore, a nonlinear relation was found between GLS (optimal boundary &lt;-15,8%; p=0,35) and SR (optimal boundary &gt;0,96/s; p=0,34) and overall survival. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions</span></span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">This study establishes baseline GLS and SR as predictors of LVEF depression in moderate AS emphasizing their role in detecting subclinical LV dysfunction. The combined use of GLS and SR may enhance the prediction of LV function decline, supporting their potential utility in planning early interventions strategies. Although their direct relationship with survival needs further exploration, these findings highlight the importance of incorporating GLS and SR in AS management to enable timely AVR and improve patient outcomes.</span></span></span></span></span></span></p>