SPC365

Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy?

Session: Comunicações Orais (Sessão 27) - Imagem 2 - Ecocardiografia e Strain
Speaker: Rita Reis Santos

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: Rita Reis Santos; João Abecasis; Sérgio Maltês; Gustavo sá Mendes; Sara Guerreiro; Carolina Campino Padrão; Pedro Freitas; António Ferreira; Regina Ribeiras; Maria João Andrade; Nuno Cardim; Victor Gil; José Pedro Neves; Sância Ramos; Miguel Mendes

<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">Relative</span><span style="font-size:10pt"> apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. </span><span style="font-size:10pt">However, it has also been described in patients with severe aortic stenosis (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 of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery.</span></span></span></span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">&nbsp;</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">We prospectively studied 135 consecutive patients (age: 73y [IQR 68&ndash;77y], 49% men) with severe symptomatic AS - mean transaortic pressure gradient (AVmean): 60.9</span><span style="font-size:10pt">&plusmn;17.7mmHg</span><span style="font-size:10pt">; mean aortic valve area: 0.7</span><span style="font-size:10pt">&plusmn;</span><span style="font-size:10pt">0.2cm<sup>2</sup>, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio&gt;1 of <em>average LS at apical segments/sum of the average basal and mid LS </em>at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3-6 months after 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">RESULTS: </span></strong><span style="font-size:10pt">RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053ms [IQR 1025&ndash;1071ms] for institutional reference values: 972-1070ms; ECV 24% [IQR 21-27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6</span><span style="font-size:10pt">&plusmn;</span><span style="font-size:10pt">10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1%[IQR 1.6&ndash;7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79,2%).</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">RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration.</span></span></span></span></p>