SPC365

Assessing left atrial and left ventricular strain imaging: Is there an improvement of atrial and ventricular function with sacubitril/valsartan?

Session: Posters - D. Heart Failure
Speaker: Pedro Brás

Congress: CPC 2021
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.4 Chronic Heart Failure – Treatment
Session Type: Posters
FP Number: ---
Authors: Pedro Garcia Brás; António Valentim Gonçalves; Luisa Moura Branco; Rita Ilhão Moreira; Tiago Pereira Da Silva; Pedro Rio; Tânia Mano; João Pedro Reis; Alexandra Castelo; Vera Ferreira; Ana Galrinho; Ana Teresa Timóteo; Ana Leal; Fernanda Varela Gameiro; Rui Cruz Ferreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Background: Strain imaging is an effective tool in the evaluation of left atrial (LA) and left ventricular (LV) function with increasing clinical value. There is limited data regarding assessment of myocardial strain in heart failure with reduced ejection fraction (HFrEF) patients (P) under sacubitril/valsartan (SV). The aim of this study was to evaluate changes in LA and LV strain imaging before and after 6 months of SV therapy in HFrEF P.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods: Prospective evaluation of echocardiographic data in HFrEF P under guideline-directed medical therapy. LA and LV parameters were assessed by 2D speckle-tracking at baseline and after 6 months of SV therapy. LA volume index (LAVi), LA longitudinal strain in reservoir phase (LASr), conduit phase (LAScd), contraction phase (LASct) and respective phases&rsquo; strain rate (SR) as well as LV end-diastolic diameter (LVDD), LV longitudinal, radial and circumferential strain and SR were compared. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Results (appendix 1): 35 P, mean age 59&plusmn;11 years, 83% male, 40% with atrial fibrillation, 43% with ischemic etiology, a mean NYHA class of 2.5&plusmn;0.6 and a baseline mean LV ejection fraction (EF) of 29&plusmn;6%.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">There was a significant reduction of LAVi (52&plusmn;23 mL/m2 vs. 44&plusmn;16 mL/m2, p= 0.004) after 6 months of SV therapy as well as improvement of LA reservoir function (LASr 11.48&plusmn;6.15% vs. 16.09&plusmn;7.8% p&lt;0.001), LA conduit function (LAScd -6.25% [IQR 4.14] vs. -7.35% [IQR 6.4], p=0.003) and LA contraction function (LASct -7.15&plusmn;4.09% vs. -10.87&plusmn;3.86% p&lt;0.001) in addition to reservoir SR (0.49&plusmn;0.22 s<sup>-1</sup> vs. 0.65&plusmn;0.22 s<sup>-1</sup>, p&lt;0.001), conduit SR (-0.47 s<sup>-1</sup> [IQR 0.39] vs. -0.58 s<sup>-1 </sup>[IQR 0.48], p=0.018) and contraction SR (-0.82 s<sup>-1</sup> [IQR 0.67] vs. -1.08 s<sup>-1</sup> [IQR 0.54], p=0.018).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">After 6 months of SV therapy, there was a significant reduction of LVDD (71&plusmn;8 mm vs. 67&plusmn;8 mm, p=0.001), and improvement of LVEF (29&plusmn;6% vs. 35&plusmn;9%, p=0.001) and longitudinal LV function: global longitudinal strain (-7.0&plusmn;2.6% vs. -8.9&plusmn;2.8%, p=0.001), systolic strain rate (SRs) (-0.32&plusmn;0.11 s<sup>-1</sup> vs. -0.47&plusmn;0.14 s<sup>-1</sup>, p&lt;0.001), early diastolic strain rate (SRe) (0.25 s<sup>-1</sup> [IQR 0.23] vs. 0.46 s<sup>-1</sup> [IQR 0.35], p&lt;0.001) and late diastolic strain rate (SRa) (0.31&plusmn;0.17 s<sup>-1</sup> vs. 0.44&plusmn;0.19 s<sup>-1</sup>, p=0.002).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Regarding radial LV function, there was a significant difference in peak radial strain (5.87% [IQR 4.9] vs. 11.74% [IQR 6.98], p&lt;0.001); SRs (0.66&plusmn;0.26 s<sup>-1</sup> vs. 0.90&plusmn;0.30 s<sup>-1</sup>, p=0.001) and SRe (-0.54&plusmn;0.48 s<sup>-1</sup> vs. -0.95&plusmn;0.72 s<sup>-1</sup>, p=0.001).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Furthermore, P showed improved circumferential LV function after SV therapy: peak circumferential strain (-7.65&plusmn;2.30% vs. -9.93&plusmn;2.46%, p=0.001), SRs (-0.78 s<sup>-1</sup> [IQR 0.39] vs. -0.87 s<sup>-1</sup> [IQR 0.37], p=0.026) and SRa (0.48 s<sup>-1</sup> [IQR 0.44] vs. 0.59 s<sup>-1</sup> [IQR 0.32], p=0.041).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusion: After 6 months of sacubitril/valsartan therapy in HFrEF P there was a significant improvement of LA longitudinal strain as well as LV systolic function, with improved longitudinal, radial and circumferential strain parameters.</span></span></p>