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Is myocardial adaptation distinct in patients with bicuspid versus tricuspid severe aortic stenosis undergoing surgical valve replacement?
Session:
SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
Speaker:
Débora Da Silva Correia
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:
Débora Da Silva Correia; Kamil Stankowski; João Abecasis; Pedro Lopes; Rita Reis Santos; Rita Lima; Telma Lima; António Ferreira; Maria João Andrade; Regina Ribeiras; Sância Ramos; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Introduction:</u> Current guidelines for aortic stenosis (AS) do not distinguish between patients with bicuspid (BAV) and tricuspid aortic valve (TAV) disease, despite notable differences in their clinical profiles and possible physiopathology. Whether these differences extend to myocardial adaptation to severe aortic stenosis remains unclear.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Aim:</u> Assess left ventricular adaptation in patients with severe symptomatic AS undergoing surgical aortic valve replacement (SAVR) according to the presence of BAV and TAV disease.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><em><u>Methods:</u></em> Single-center, prospective cohort study of 158 patients with severe symptomatic AS (mean age 71±8 years, 50% male; mean transaortic gradient 61±17 mmHg, indexed aortic valve area 0.4±0.1 cm²/m², LVEF 58±9%) referred for SAVR between 2019 and 2022. Patients with prior cardiomyopathy, moderate/severe aortic regurgitation, or severe non-AS valve dysfunction were excluded. Serial transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) were performed within 3 months before SAVR to assess LV remodeling and myocardial tissue characterization (T1 mapping, late gadolinium enhancement [LGE], and extracellular volume-[ECV]</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">). Myocardial tissue obtained during SAVR (myocardial biopsy at LV basal septum or harvested from surgical myectomy specimens) underwent fibrosis quantification with Masson’s trichrome satin at an automatic algorithm platform-QuPathTM. Valve morphology was assessed via TTE or surgical reports. Clinical, imaging, and histopathological data on LV adaptation were compared between patient groups.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><em><u>Results</u></em><em>: (Table 1)</em> A total of 123 patients were included (mean age of 71±9 years; 50% male), 13% with BAV and 87% with TAV (25 patients with undetermined valve morphology). All BAV cases exhibited the ascending phenotype without root involvement. BAV patients were younger, predominantly male, with lower prevalence of hypertension. Aortopathy was more prevalent in BAV patients (p<0.001). Clinical presentation and AS severity indexes were similar between groups except for higher mean transvalvular gradients in BAV (<em>p</em>=0.022). Patients with BAV had higher LV mass (92[IQR 74] vs. 71[IQR 31] g/m²,p=0.008) and positive remodeling at pre-operative CMR (1.04[IQR 0.3] vs. 0.92[IQR 0.2],p=0.037). Neither non-invasive myocardial tissue characterization at CMR nor myocardial fibrosis content at biopsy differed among the groups. Surgical bioprosthesis were more commonly implanted in patients with TAV (p<0.001). Accordingly, BAV patients had higher rates of concomitant ascending aorta grafts at SAVR.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Conclusion:</u> In severe symptomatic aortic stenosis, clinical presentation is indistinct regardless of valve morphology, except for higher prevalence of aortopathy in BAV patients. Pressure overload is probably the main driver of LV adaptation, as myocardial tissue characterization is similar in both groups of patients.</span></span></p>
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