SPC365

Left ventricular remodeling in aortic stenosis patients referred for surgical aortic valve replacement

Session: Comunicações Orais (Sessão 11) - Imagem 1 - TC e RM Cardíaca e Cardiologia Nuclear
Speaker: Rita Reis Santos

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.3 Cardiac Magnetic Resonance
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Reis Santos; João Abecasis; Sérgio Maltês; Gustavo sá Mendes; Luís Oliveira; Eduarda Horta; Sara Guerreiro; Pedro Freitas; António Ferreira; Regina Ribeiras; Maria João Andrade; Nuno Cardim; Victor Gil; Miguel Mendes; José Pedro Neves

<p style="margin-right:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt">BACKGROUND: </span></strong><span style="font-size:10pt">Left ventricular (LV) hypertrophy is a common expected finding in aortic stenosis (AS) patients. </span><span style="font-size:10pt">Cardiac magnetic resonance (</span><span style="font-size:10pt">CMR) plays an important role as a </span><span style="font-size:10pt">non-invasive method for determining LV mass and volume, and to characterize the LV remodeling response in AS. </span></span></span></span></p>

<p style="margin-right:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt">AIM: </span></strong><span style="font-size:10pt">To assess the prevalence, to describe the p</span><span style="font-size:10pt">atterns and evolution of LV remodeling (by CMR) in AS patients referred for surgical aortic valve replacement (AVR).</span></span></span></span></p>

<p style="margin-right:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt">METHODS: </span></strong><span style="font-size:10pt">Single-center prospective cohort of 134&nbsp;consecutive </span><span style="font-size:10pt">patients </span><span style="font-size:10pt">(73years [68-77years], 49% men] </span><span style="font-size:10pt">with severe AS: </span><span style="font-size:10pt">mean transaortic pressure gradient (AVmean): 61 </span><span style="font-size:10pt">&plusmn;</span><span style="font-size:10pt"> 1.5 mmHg; aortic valve area (AVA): 0.7 </span><span style="font-size:10pt">&plusmn;</span><span style="font-size:10pt"> 0.1 cm<sup>2</sup>, referred for surgical AVR, with </span><span style="font-size:10pt">no previous history of ischemic </span><span style="font-size:10pt">cardiomyopathy</span><span style="font-size:10pt">. Before surgery, all patients underwent electrocardiogram, complete transthoracic echocardiogram (TTE) and CMR for LV assessment and tissue characterization (</span><span style="font-size:10pt">mean LV indexed mass [LVMi]: 80.3&plusmn;26.5g/m<sup>2</sup>; mean end-diastolic LV indexed volume [LVEDVi]: 84.4<span style="color:black">&plusmn;24.5 mL/</span>m<sup>2</sup> and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81 &ndash; 1.08 g/mL]<span style="color:black">).</span></span><span style="font-size:10pt"> Patterns of LV remodeling were investigated before and after AVR by CMR measurements of LVMi, LVEDVi and </span><span style="font-size:10pt">M/V. Besides normal LV ventricular structure, </span><span style="font-size:10pt">four other </span><span style="font-size:10pt"><span style="color:black">patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy,</span></span> <span style="font-size:10pt"><span style="color:black">and adverse remodeling (Figure 1).</span></span></span></span></span></p>

<p style="margin-right:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt">RESULTS: </span></strong><span style="font-size:10pt"><span style="color:black">Overall, </span></span><span style="font-size:10pt">43% (n=58) of the patients had <span style="color:black">concentric hypertrophy, 30% (n= 40) concentric remodeling, 22% (n=29) normal ventricular geometry, 4% (n=5) eccentric hypertrophy and in two patients we observed an adverse remodeling pattern. </span></span><span style="font-size:10pt">AVR was performed in 80 patients. At the 3<sup>rd</sup> to 6<sup>th</sup> month post-AVR assessment, </span><span style="font-size:10pt"><span style="color:black"><span style="background-color:white">LV remodeling changed to:</span></span></span><span style="font-size:10pt"> <span style="color:black">normal ventricular geometry in </span>46%<span style="color:black">, concentric remodeling in 31%, concentric hypertrophy in 19%, eccentric hypertrophy in 3% and adverse remodeling in only one patient (Figure 1).</span></span></span></span></span></p>

<p style="margin-right:-38px; text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="color:black">CONCLUSIONS: </span></span></strong><span style="font-size:10pt"><span style="color:black">in this group of patients with severe aortic stenosis, concentric hypertrophy was not the sole pattern of LV remodeling and one&nbsp;out of every five still presented a normal ventricular geometry and mass as assessed by CMR. LV response was dynamic after AVR which stands for complex and multifactorial interaction in these group of patients despite similar valvular pathophysiology and therapeutic intervention.</span></span></span></span></span></p>