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Global longitudinal strain indices prior to aortic substitution predicts post intervention outcomes
Session:
Painel 9 -Doença Valvular 3
Speaker:
SARA ISABEL LOPES FERNANDES
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sara Lopes Fernandes; Beatriz Saldanha Santos; Margarida S. Cabral; Rita Ribeiro Carvalho; Luís Graça Santos; Fernando Montenegro Sá; Catarina Ferreira Ruivo; Francisco Soares; Hélia Martins; Joao Morais
Abstract
<p><strong>Introduction:</strong> Global longitudinal strain (GLS) is often reduced in severe aortic stenosis (SAS); nevertheless its impact on prognosis after aortic valve intervention (AVI) is not well established.</p> <p><strong>Aim: </strong>To determine the impact of moderate to severely reduced pre-intervention GLS on clinical outcomes after AVI.</p> <p><strong>Methods: </strong>Retrospective study of 78 patients submitted to severe aortic stenosis intervention (n=73, 94% surgical aortic valve replacement and n=5, 6% transcatheter aortic valve implantation). Baseline clinical, demographical and echocardiographic data were collected. Two groups were defined to GLS (moderate to severely reduced [<-13%] - Group 1, and mildly reduced to normal [≥13%] – Group 2). The primary endpoint was a composite of hospitalization due to heart failure and all-cause mortality. Forward stepwise logistic regression was used to assess the independent association of GLS with the primary endpoint, along with relevant covariables. The model was tested for calibration with the Hosmer and Lemeshow test, and for goodness-of-fit with receiver operating characteristic (ROC) curve.</p> <p><strong>Results: </strong>Mean age was 71 ± 10 years in group 1 and 71 ± 8 years in group 2, p=0.824; Group 1 had more male patients (n=25, 78% vs n=26, 57%, p=0.049), and had more severe symptoms (NYHA class ≥III n=12, 38% vs n=5, 11%, p=0.005). In group 1 left ventricular (LV) ejection fraction was lower (53 ± 8% vs 60 ± 6%, p<0.001), with more LV hypertrophy (interventricular septum 16 ± 3mm vs 14.5 ± 2mm, p=0.02; LV mass 179 ± 31 g/m2 vs 137 ± 36 g/m2, p=0.015) and higher E/e´ (17 ± 5.6 vs 14 ± 4.3, p=0.012). More patients in group 1 reached the primary endpoint (n=10, 31% vs n=3, 7%; p=0.004). After multivariate analysis, moderate to severely reduced GLS remained an independent predictor of the composite endpoint (OR 7.3, 95% CI 1.5-35, p=0.013), along with permanent pacemaker status (OR 12.8, 95% CI 3-60, p=0.001). The model showed good calibration (Hosmer & Lemeshow test p=0.921) and discrimination (AUC 0.84, p<0.001).</p> <p><strong>Conclusion: </strong>Moderate to severely reduced GLS (<-13%) prior to valve aortic intervention predicts worse postoperative clinical outcome with respect to hospitalisation due to heart failure and all-cause mortality.</p>
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