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Native T1 mapping abnormalities in patients with aortic stenosis. Relationship with clinical features and strain changes assessed by tissue tracking
Session:
CO 17 - Doença Valvular
Speaker:
Ana G. Almeida
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana G. Almeida; GUSTAVO SILVA; Patricia Barros; Cláudio David; Luis Bras Rosario; Inês Aguiar Ricardo; Joana Rigueira; P. Carrilho Ferreira; Fausto José Pinto
Abstract
<p>In patients with aortic stenosis, myocardial fibrosis underlines the progression to LV dysfunction, which impacts prognosis and clinical decision. Diffuse fibrosis may be assessed currently by CMR using T1 mapping, Additionally, deformation abnormalities of LV myocardium may precede changes in LV ejection fraction and influence the prognosis. We aimed to assess the presence of diffuse fibrosis by native T1 mapping in patients with severe aortic stenosis and its association with strain changes and the clinical features and biomarkers.</p> <p><strong>METHODS: </strong>We included consecutive patients with severe aortic stenosis as assessed by echocardiography according to EACVI and ASE guidelines Patients with atrial fibrillation or coronary artery disease and EF<50% were excluded. Using CMR, we assessed the native T1 mapping by MOLLI sequence at a 3T system and the peak global longitudinal strain, using feature tracking from cine SSFP series. Areas of replacement LGE were also evaluated. NYHA class and NTproBNP values were also assessed,</p> <p><strong>RESULTS: </strong>45 patients (63 year-old, 66% male) and 17 healthy individuals (62 year-old, 62% male) as controls were included. In comparison with controls, LV volumes and mass were significantly higher in the patients group (p <0.001). LGE was absent both in the patient’s and control groups. Native T1 values differed significantly between patients and control subjects (1256±38 vs.1125±18 msec, p-value<0.004). In patients’ group, T1 values correlated significantly with peak global longitudinal strain by tissue tracking (r=0.61, p =0.001), with indexed left atrial volume (r=0.41, p=0.02) and with NTproBNP values (p=0,002). 26 patients who presented with NYHA class II/III and/or exercise angina showed significantly higher T1 values and lower global longitudinal strain in comparison with asymptomatic patients (p=0.001 and p=0.01, respectively).</p> <p><strong>Conclusion:</strong> Native T1 values using MOLLI sequence in patients with aortic stenosis were significantly higher than in controls suggesting the presence of myocardial fibrosis. Moreover, in symptomatic patients, T1 values and global longitudinal strain were significantly different from asymptomatic patients. CMR T1 mapping may provide tools for early detection of myocardial disease, and potentially participate in the decision on timing to operate on and thus influence the post-operative recovery and outcomes</p>
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