SPC365

Left atrial strain analysis in patients with severe rheumatic mitral stenosis submitted to Mitral Balloon Valvuloplasty

Session: Comunicações Orais (Sessão 27) - Imagem 2 - Ecocardiografia e Strain
Speaker: João Presume

Congress: CPC 2022
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.1 Echocardiography
Session Type: Comunicações Orais
FP Number: ---
Authors: João Presume; Daniel Gomes; Mariana Paiva; Francisco Albuquerque; Joana Ferreira; Sara Guerreiro; Liliana Marta; Pedro Freitas; João Abecasis; Marisa Trabulo; Maria João Andrade; Pedro Araújo Gonçalves; Manuel Almeida; Miguel Mendes; Regina Ribeiras

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Introduction</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">Left atrial (LA) strain is a novel tool to evaluate LA dysfunction. Little is known about its role to evaluate patients with severe rheumatic mitral stenosis (MS) treated with balloon mitral valvuloplasty (MBV). The aim of our study was to assess the prognostic impact of peak atrial longitudinal strain (PALS) and LA ejection fraction (EF) in a cohort of patients with severe rheumatic MS. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Methods</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">We conducted a single-centre retrospective study enrolling patients with rheumatic mitral stenosis submitted to mitral balloon valvuloplasty (MBV) from 2010 to 2021. All patients included underwent transthoracic echocardiogram before and after the procedure. PALS and LAEF were assessed by 2D speckle tracking in apical 4-chamber view (as per EACVI current recommendations). PALS variation after MBV was assessed by the difference between PALS after MBV and PALS before MBV. The primary outcome was a composite of mitral valve surgery or death. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Results</span></u></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">A total of 26 patients were included (50&plusmn;19 years old, 19% male), 54% with permanent atrial fibrillation. Overall, the main echocardiographic findings of this cohort before intervention were: median anatomical and functional mitral valve area of 1.1 [0.6;1.2] and 1.3 cm<sup>2 </sup>[0.7;1.3], respectively; median mean transmitral gradient of 9 mmHg [7;23]; median Wilkins score of 9 [6;10]; and a median pulmonary artery systolic pressure of 56 [40;80] mmHg. MVB resulted in the following results: a median anatomical valve area of 2.0 [1.3;2.3]cm<sup>2</sup>; median mean transmitral gradient of 5 [4;9] mmHg; median pulmonary artery systolic pressure of 41 [32;50] mmHg; and only 2 patients ended up with moderate mitral regurgitation (no severe cases).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">During a mean follow-up of 33&plusmn;23 months, the primary outcome occurred in 9 (34.6%) patients (5 submitted to surgery, 4 died).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">On LA strain analysis before the procedure, mean PALS was 10&plusmn;4% and mean LAEF was 26&plusmn;11%. After MBV, there was a significant increase in PALS to 14% (p=0.004) and in LAEF to 36% (p&lt;0.001) &ndash; table 1a.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">On univariate cox regression (table 1b), LAEF was significantly associated with the primary outcome (HR 0.864; 95%CI 0.747-0.999). There was also a non-significant positive trend for PALS (HR 0.857; 95%CI 0.699-1.050) and PALS variation after MBV (HR 0.871, 95%CI 0.738-1.028). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="font-family:AppleSystemUIFontBold">Conclusion</span></u></strong> </span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:AppleSystemUIFont">LA strain and EF seem to be significantly impaired in severe rheumatic MS. Moreover, our findings highlight these markers as potentially useful prognostic markers in rheumatic MS.</span></span></span></p>