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Global circunferencial strain as a predictor of disease progression in patients with bicuspid aortic valves
Session:
Painel 10 - Doença Valvular 10
Speaker:
Alexandra Castelo
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
20. Congenital Heart Disease and Pediatric Cardiology
Subtheme:
20.3 Congenital Heart Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Alexandra Castelo; Sílvia Rosa; Ana Galrinho; Luisa Moura Branco; Lidia De Sousa; Pedro Garcia Brás; Vera Ferreira; Tânia Branco Mano; Rui Cruz Ferreira
Abstract
<p>Introduction: Bicuspid aortic valve (BAV) is frequently associated with aortic valve stenosis (AS) or regurgitation (AR) and aortic enlargement (AE). Disease progression has high interpersonal variability.</p> <p>Purpose: The aim of this study was to evaluate global circunferential strain (GCS) of aortic valve as a predictor of disease progression in patients with BAV.</p> <p>Methods: Retrospective analysis of echocardiographic and clinical evolution of BAV patients (P). Clinical and echocardiographic features were collected at baseline and through a follow up period of 78±2 months. Primary endpoints: AS worsening; AR worsening; aortic valve replacement (AVR); AE. Combined secondary endpoints: AS worsening + AR worsening; AS worsening + AE; AR worsening + AE; AS worsening + AVR; AR worsening + AVR; AS worsening + AR worsening + AVR; AS worsening + AR worsening + AE; AS worsening + AR worsening + AVR + AE.</p> <p>Results: 54 P (70.4% male) were included, with a median age of 34± 11. 20.4% of P had aortic coarctation and 11.1% had an interventricular communication. 25.9% P had a history of cardiac surgery, the majority of them (18.5%) a coarctation correction, 1.9% a valvulotomy, 3.7% a interventricular communication closure and 5.6% a patent ductus arteriosus closure. The most frequent BAV pattern was fusion of right and left coronary cusps (55.6%), following by right and non-coronary cusps fusion (31.5%), BAV with two cusps without raphe (7.4%) and left and non-coronary cusps fusion (5.6%). At baseline all patients had good left ventricular systolic function, 77.8% had AR and 38.9% had AS, with an average maximum gradient of 49±5.48mmHg, mean gradient of 30±3.5mmHg and valvular area of 1.3±0.27cm<sup>2</sup>. The mean GCS was 4.41±0.79%. 38.9% had AE (71.4% ascending aorta and 28.6% aortic root + ascending aorta). At baseline GCS did not correlated with AS severity (p=0.731), mean gradient (p=0.0449), maximum gradient (P = 0.561), aortic root dimension (p = 0.107) or ascending aorta dimension (p = 0.063). On follow up, 2P (3.7%) died, 16P (29.6%) had a hospitalization and 14P (25.9%) had an AVR (64.3% with a simultaneous aortic conduit implantation). 20.4% P had worsening of AR, 24.1% of AS and 65.6% of AE. GCS at baseline correlated with AS worsening (p = 0.043) and with AS worsening + AE (p = 0.02) and AR worsening + AS worsening + AE (p = 0.019). Other predictors of AS worsening were dyslipidemia (p = 0.018) and annulus calcification (p = 0.05), with GCS and calcification being independent predictors (p = 0.028 and p = 0.023). GCS was also an independent predictor of the combined endpoint AS worsening + AE (p = 0.049). GCS was not a predictor of mortality (p = 0.583), hospitalization (p = 0.619) or valvular and aortic intervention (p = 0.373).</p> <p>Conclusion: BAV is a risk factor for aortic valve dysfunction and aortic enlargement. GCS at baseline was an independent predictor of disease progression, including AS worsening and AS worsening + AE.</p>
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