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PREVALENCE AND DETERMINANTS OF RIGHT VENTRICULAR DYSFUNCTION IN PATIENTS WITH SEVERE SYMPTOMATIC HIGH GRADIENT AORTIC STENOSIS
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
Sérgio Maltês
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Sérgio Maltês; Joao Abecacis; Gustavo sa Mendes; Carolina Padrão; Carla Reis; Sara Guerreiro; Pedro Freitas; Regina Ribeiras; Maria João Andrade; Nuno Cardim; Vitor Gil; Miguel Mendes
Abstract
<p style="margin-right:-38px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">BACKGROUND: </span></strong><span style="font-size:10.0pt">Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development. </span></span></span></p> <p style="margin-right:-38px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">AIM: </span></strong><span style="font-size:10.0pt">to describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload. </span></span></span></p> <p style="margin-right:-38px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">METHODS: </span></strong><span style="font-size:10.0pt">we prospectively studied 93 consecutive patients </span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">(age: 73 years </span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">[</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">IQR 68-77</span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">]</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?""> years, 55% women) </span></span><span style="font-size:10.0pt">with pure severe symptomatic high gradient aortic stenosis: </span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">mean transaortic pressure gradient: 57.0mmHg </span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">[</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">IQR 46.9-71.1</span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">]</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">; aortic valve area: 0.72cm<sup>2</sup> </span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">[</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">IQR 0.61-0.88</span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">]</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">; indexed stroke volume: 48.8 </span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">±</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">1.5 mL/m<sup>2</sup> (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: <span style="color:black">56.0% [51.0-61.3]; </span>GLS: -14.5% </span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">[</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">IQR -16.1- -10.6</span></span><span style="font-size:10.5pt"><span style="font-family:Symbol">]</span></span><span style="font-size:10.5pt"><span style="font-family:"P‚÷\0027EF?"">), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume).</span></span><span style="font-size:10.0pt"> Normal RV function was defined according to TAPSE </span><span style="font-size:10.0pt"><span style="font-family:Symbol">³</span></span><span style="font-size:10.0pt"> 17mm, tricuspid annular systolic velocity </span><span style="font-size:10.0pt"><span style="font-family:Symbol">³</span></span><span style="font-size:10.0pt"> 12cm/s, mean free wall longitudinal strain </span><span style="font-size:10.0pt"><span style="font-family:Symbol">£</span></span><span style="font-size:10.0pt"> -20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) - 1 normal parameter (12.9%), (2) - 2 normal parameters (44.1%), (3) - 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0,1,2 vs. group 3) at multivariate regression analysis.</span></span></span></p> <p style="margin-right:-38px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">RESULTS: </span></strong><span style="font-size:10.0pt">Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction.</span></span></span></p> <p style="margin-right:-38px; text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt">CONCLUSION: </span></strong><span style="font-size:10.0pt">RV dysfunction<strong> </strong>is common in this group of patients with severe high gradient<strong> </strong>aortic stenosis and preserved ejection fraction<strong>. </strong>RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence.</span></span></span></p>
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