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Aortic valve replacement in severe aortic stenosis: a robuste impact in cardiac reverse remodelling
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Sofia S. Martinho
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.4 Valvular Heart Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Sofia S. Martinho; José Almeida; Cátia Ferreira; André Freitas; Valdirene Gonçalves; João André Ferreira; João Rosa; Gustavo Campos; Fátima Franco; Rogerio Teixeira; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">BACKGROUND:</span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Arial",sans-serif"><span style="color:black"> Aortic stenosis (AS) is the most common valve disease and a prototype model for afterload-induced heart failure. Progressive aortic valve stenosis affects the left ventricle, which adapts with left ventricular (LV) hypertrophy (LVH)</span></span></span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">. We aimed to</span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Arial",sans-serif"><span style="color:black"> assess cardiac </span></span></span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">reverse remodeling</span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Arial",sans-serif"><span style="color:black"> parameters after aortic valve replacement in patients with severe aortic stenosis.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">METHODS</span></span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">: We conducted a retrospective, observational study of 50 patients with previous diagnosis of severe aortic stenosis, submitted to surgical or percutaneous valve replacement between 2011 and 2017. </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">All underwent a comprehensive echocardiography, at baseline and 1-year after valvular replacement with evaluation of cardiac structure and function (LV ejection fraction (LVEF), volumes and diameters, mass, stroke volume (SVi) and septal (SIV) and posterior (PW) wall thickness and right ventricular fractional change (FAC)) plus the assessment of cardiac mechanics with 2D speckle-tracking echocardiography focusing on LV global longitudinal strain (GLS), and the Left atrium (LA) peak longitudinal strain (PALS) </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">RESULTS: Mean age was </span></span><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif">79±3 years and 58% were male. At baseline, 88% were on NYHA II and 12% in NYHA III-IV functional class. Most of the patient were submitted to surgical replacement (n=48). <span style="color:black">Functional class improved significantly, 1-year after valve replacement, most patients were in in NYHA I (76%), p<0.001. Regarding echocardiography, we found a significant improvement in LV mass, SIV, PW, and </span>SVi<span style="color:black"> [ </span>-31±50 g/m<sup>2</sup> <span style="color:black">(95%CI -46 to -16, p<0.001), </span>-1.6±2.6 mm <span style="color:black">(95%CI -2.3 to -0.8, p<0.001), </span>-1.7±2.3 mm <span style="color:black">(95%CI -2.4 to -1.1, p<0.001) and </span>4±12 mL/ m<sup>2</sup> <span style="color:black">(95%CI 0.2 to 7.8, p=0.041), respectively], although there was a discrete decrease in LVEF </span><span style="background-color:white"><span style="color:black">without statistical difference.</span></span><span style="color:black"> LAV had also a significant decrease, -11</span>±13 mL <span style="color:black">(95%CI -15 to -7, p<0.001). Regarding the assessment of cardiac mechanics, we identified </span>an improvement in<span style="color:black"> GLS [-15</span>±5 to -17±5%, <span style="color:black">-2.5</span>±6% <span style="color:black">(95%CI -4,7 to -0.4, p=0.023)], and PALS, the last one </span><span style="background-color:white"><span style="color:black">without statistical difference.</span></span> </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Arial",sans-serif"><span style="color:black">CONCLUSIONS: We observed that in patients with severe aortic stenosis submitted a valve replacement had 1-year significant clinical improvement, who may be explained by a robust impact on cardiac reverse remodelling.</span></span></span></span></span></p>
Slides
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