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Myocardial work indexes in adult patients with repaired aortic coartation.
Session:
Painel 10 - Doença Valvular 10
Speaker:
Ana Teresa Timóteo
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Ana Teresa Timóteo; Luisa Moura Branco; Ana Galrinho; Tânia Branco Mano; Lidia De Sousa; Ana Figueiredo Agapito; Rui Cruz Ferreira
Abstract
<p>Background: Myocardial strain analysis is a tool that allows a more precise assessment of cardiac performance. However, strain is relatively load dependent. New tools have been developed, with afterload adjustment. It was our objective to assess myocardial work (MW) in patients with repaired aortic coartation (ACo).</p> <p>Methods: Study of consecutive adult patients with corrected ACo submitted to a complete routine transthoracic echocardiogram in 2018 at our centre. Patients with an aortic valve prosthesis, more than mild aortic stenosis / regurgitation, with pacemaker or with other non-corrected congenital heart diseases (with the exception of bicuspid aortic valve were excluded from the analysis. A semi-automated strain analysis was performed with speckle tracking technology and both longitudinal strain and MW were estimated using GE software. Blood pressure was simultaneously measured in the patient’s right arm. The following parameters were specifically assessed: Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE)</p> <p>Results: Thirty-two patients were included in the study, with a mean age of 38 ± 10 (24 – 62) years, 37% males. Mean body surface area was 1.7 and repair was performed at a mean age of 12 years. In this group of patients, 50% were hypertensives and in 66% there was a concomitant bicuspid aortic valve. Median maximum aortic valve gradient was 10 mmHg and median descending aortic gradient was 17 mmHg. Compared to reference values for a normal population (previously published), repaired ACo patients had lower values of MW, with the exception of GWE (Table). In multivariate linear regression analysis, independent predictors of GWI are systolic blood pressure (β=0.332, p=0.047) and let atrial volume indexed (LAVI) (β=0.405, p=0.01). For GCW, systolic blood pressure (β=0.463, p=0.003) and LAVI (β=0.443, p=0.005). For GWW, age at intervention (β=0.384, p=0.022) and LAVI (β=-0.334, p=0.044). For GWE, the only predictor was LAVI (β=0.458, p=0.008). The presence of bicuspid aortic valve, aortic valve gradient and descending aortic gradient did not have any influence in MW parameters, although patients with higher aortic valve gradients were excluded from this study.</p> <p>Conclusion: Adult patients with repaired ACo, present lower MW indices (with the exception of GWE) and the main determinant for that difference are LAVI and systolic blood pressure.</p>
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