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Impact of Diastolic Dysfunction in Patients with Moderate Aortic Stenosis
Session:
SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
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
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Aortic stenosis (AS) induces an adaptative ventricular remodelling with left ventricular (LV) hypertrophy and fibrosis, eventually leading to ventricular diastolic and systolic dysfunction. This can lead to poorer outcomes and reduced survival. </span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Aim</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This study aims to investigate the prevalence, incidence and prognostic implication of LV diastolic dysfunction (DD) in patients with moderate AS and preserved LV ejection fraction.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">A total of 595 patients with a first diagnosis of moderate AS, preserved LV systolic function and consecutive echocardiograms were retrospectively identified. DD was defined based on the presence of at least 3 of 4 parameters: 1) average E/e’; 2) septal e’ velocity <7cm/s or lateral e’ velocity <10cm/s; 3) tricuspid regurgitation velocity>2.8 m/s; and 4) left atrium volume index>34 mL/m<sup>2</sup>. <span style="color:black">This study assessed the prevalence and incidence of DD and the predictors of new-onset DD. Furthermore, univariable and multivariable Cox models </span><span style="color:#0f0f0f">evaluated the association of new-onset DD as a time-dependent covariate and the composite endpoint of all-cause mortality or aortic valve replacement (AVR).</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The baseline prevalence of DD was 43%. These patients were older, more likely female, and had higher prevalence of atrial fibrillation (AF), despite similar aortic valve areas and comorbidities, compared with patients without DD. Over a median follow-up of 1,98 years, 32% patients developed new-onset DD, with 50% of these cases occurring when AS was still moderate. Decreasing AVA (HR 1,07; 95% IC 1,02-1,12), increasing LV mass index (HR 2,60; 95% IC 1,19-4,00) and increasing LV sphericity index (1,22; 95% IC 1,01-1,46) predicted higher risk of new-onset DD, after multivariate adjustment. Incident DD was independently associated with the composite endpoint<span style="color:#0f0f0f"> of all-cause mortality or AVR (HR 1,77; 95% IC 1,37-2,77)</span>.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">This study reveals a high prevalence of DD at the diagnosis of moderate AS and preserved LV ejection fraction, with its incidence increasing alongside AS progression and adverse LV remodeling. LV DD independently correlates with an increased risk of all-cause mortality and AVR in this patient group. These findings highlight the importance of diastolic LV function assessment in the risk stratification of patients with moderate AS.</span></span></p>
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