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CPC 2018
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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Abstract
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CLEAR FILTERS
Going beyond classic echo in aortic stenosis: is left atrial mechanics a marker of severity?
Session:
CO 08 - Ecocardiografia
Speaker:
Patrícia M. Alves
Congress:
CPC 2018
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Patrícia M. Alves; Ana Vera Marinho; João André Ferreira; James Milner; Manuel Oliveira Santos; Rui Baptista; Rui M. Martins; Mariano Pêgo
Abstract
<p>BACKGROUND: Left atrial (LA) strain is a prognostic marker in mitral valvulopathy and is correlated to pulmonary hypertension in heart failure. Meanwhile, in aortic valve stenosis (AS) there is limited information regarding LA mechanics. We assessed LA mechanics in AS through speckle-tracking (STE) to determine variations in different levels of disease severity and prognosis.</p> <p>METHODS: We included 82 patients diagnosed with severe AS (sAS) and 64 patients with moderated AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics was assessed through STE: global LA strain and LA strain rate during systole (LAsys and SRs), early diastole (LAe, SRe), and late diastole (LAa, SRa) were measured, corresponding to LA reservoir, conduit and contractile functions, respectively. STE-derived left ventricle global longitudinal strain (LV-GLS) was also calculated. The cohort was followed up during a median of 30 [IQR 12.6-50] months and outcomes (admission for heart failure [HF] and death) determined.</p> <p>RESULTS: The mean age was 76±7.9 years and 51% were male. Mean values of LV-GLS were -17.7±3.9%, indexed LA volume (LAVi) 41 ml.m<sup>-2</sup>, E/e’ ratio 17.2±2%, TAPSE 20.3±3.5 mm, RV/RA gradient 24.1±10 mmHg. In our sample, LV-GLS (-18.5% vs -17.1, p=0.025), E/e’ ratio (15.8 vs 18.4, p=0.03) and global LA mechanics (LAsys 23% vs 13.8%, p<0.001) had worse values in sAS. However, LAsys (AUC 0.85, 95%CI 0.78-0.90, p<0.001), LAe (AUC 0.83, 95%CI 0.75-0.88, p<0.001) and LAa (AUC 0.80, 95%CI 0.70-0.84, p<0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LAsys showed a stronger correlation with both aortic valve area (r<sup>2</sup>= 0.6, p<0.001) and mean LV-aortic gradient (r<sup>2</sup>=0.55, p<0.001), than LV-GLS (r<sup>2</sup>=0.3 and r<sup>2</sup>=0.25, p=0.01). Regarding the combined outcome of HF and death, both LV-GLS (HR 1.16, 95%CI 1.06-1.27, p=0.002) and LAsys (HR1.13, 95%CI 1.02-1.26, p=0.038), but not E/e ratio, TAPSE or RV/RA gradient, were significant predictors.</p> <p>CONCLUSIONS: LA global strain was the best discriminator of severity, surpassing E/e’ ratio and LV-GLS, and a significant predictor of prognosis in aortic stenosis. </p>
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