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Myocardial work by echocardiography in patients with bicuspid aortic valves
Session:
Painel 10 - Doença Valvular 10
Speaker:
Tânia Branco Mano
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Tânia Branco Mano; Luisa Moura Branco; Sílvia Aguiar Rosa; Ana Teresa Timóteo; Ana Galrinho; Joao Abreu; Ana Figueiredo Agapito; Lidia De Sousa; André Viveiros Monteiro; Dra. Inês Rodrigues; Tiago Mendonça; António Valentim Gonçalves; João Pedro Reis; Ana Leal; Fernanda Varela Gameiro; Rui Cruz Ferreira
Abstract
<p>The degree of cardiac remodelling and clinical symptoms in bicuspid aortic valves (BAV) is largely variable. New echocardiographic indices of left ventricle (LV) function as myocardial work (MW) can detect subtle alterations in myocardial mechanics and emerge as promising tools for improving risk stratification.</p> <p>Objectives: The aim was to evaluate MW by transthoracic echocardiography (TTE): Global Constructive Work (GCW), Global Wasted Work (GWW) and Myocardial Work Efficiency (MWE) in patients (pts) with BAV.</p> <p>Methods: Retrospective analysis of pts with BAV, who underwent TTE study in our tertiary reference centre between December 2017 and November 2019. MW indices were calculated using vendor-specific software through a combination of global longitudinal strain (GLS) and non-invasive estimation of LV pressure (brachial cuff pressure). In pts with severe aortic stenosis, a second calculation was made adding maximum aortic valvular gradient to systolic brachial pressure. Pts with previous heart valve surgery and non-optimal quality imaging were excluded.</p> <p>Results: Total of 64 pts: 75% males, mean age 38.6 ± 11.3 years, 30% with arterial hypertension, 19% with aortic coarctation and 22% symptomatic. The main echocardiographic features are described in Table 1. Mean GLS was -18.6±2.8, systolic blood pressure 118±14.5 mmHg and diastolic pressure 68.6±10.2mmHg. Mean MW indices: GCW 2161±1305 mmHg, GWW 89.4±53.7 mmHg and MWE 94.5%±3.1. Pts with severe aortic stenosis (N=11) had similar mean MWE between the two calculations (92.7%) that were significantly lower than other pts (92.7% vs 94.8%, p=0.041, OR 0.9), higher mean GCW (2901 vs 2050mmHg, p<0.001), non-significant higher GWW (123 vs 90mmHg, p=0.078) and non-significant difference in GLS (-17.7 vs -18.7, p=0.279). Symptomatic pts had also lower GWE (p=0.002, OR 0.85) and higher GWW (p=0.025, OR 16.39). We also found an inverse correlation between LV mass index and MWE (p=0.008, -0.342). Pts with severe aortic regurgitation had non-significant lower MWE and GLS values.</p> <p>Conclusion: To our knowledge this is the first study to evaluate MW in BAV. In this population with preserved LV ejection fraction, symptomatic pts and those with severe aortic stenosis had significantly lower GWE while no difference in GLS. The inverse correlation between LV mass index and GWE highlight the less energetically efficiency of hypertrophic hearts. Further studies are needed to address the association between MW, prognosis and risk stratification in this population.</p>
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