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Left ventricular reverse remodeling in post operative aortic stenosis patients: prevalence and predictor(s)
Session:
Posters (Sessão 2 - Écran 8) - Doença Valvular 2 - Foco no Ecocardiograma na Válvula Aórtica
Speaker:
Rita Reis Santos
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rita Reis Santos; João Abecasis; Sérgio Maltês; Pedro m. Lopes; Gustavo sá Mendes; Daniel a. Gomes; Sara Guerreiro; Pedro Freitas; António Ferreira; Regina Ribeiras; Maria João Andrade; Nuno Cardim; Victor Gil; Miguel Mendes; José Pedro Neves
Abstract
<p style="margin-right:-9px; text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">BACKGROUND: </span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><span style="background-color:white">In patients with severe aortic stenosis (AS), left ventricular (LV) remodeling is believed to be a compensatory adaptive process which should reverse after aortic valve intervention. However, this is not always the rule and remodeling persistence may negatively impact post-procedural outcomes and survival. </span></span></span></span></span></span></span></p> <p style="margin-right:-9px; text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">AIM:</span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"> To assess the prevalence and predictors of morphological LV reverse remodeling in severe symptomatic AS patients after surgical aortic valve replacement (AVR).</span></span></span></span></span></p> <p style="margin-right:-9px; text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">METHODS: </span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">We prospectively studied 75 patients (72y <span style="color:black">[68-77y]</span>, 45% male) with severe symptomatic AS - mean gradient (AVM): 61±17mmHg; mean indexed aortic valve area (AVAi) 0.41±0.10 cm</span></span><sup><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif">2</span></span></sup><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">/m<sup>2</sup> with no previous history of ischemic cardiomyopathy, all with high gradient, 4 with low-flow, 81% with hypertension, 27% with type 2 diabetes mellitus and 35% patients with stage 3 chronic kidney disease: median MDR creat clearance: 70.4mL/min <span style="color:black">[40-102]</span>. All patients performed pre-operative cardiac magnetic resonance (CMR) at a mean period of 3.4months (0-17 months) before AVR and at the 3-6<sup>th</sup> months after AVR, for LV reverse remodeling assessment. It was defined as at least the occurrence of one of the following: >15% reduction in LVEDVi; >15% reduction in LVMi by CMR; >10% reduction in geometric remodeling ratio. Clinical, AV severity data, preoperative functional LV and tissue characterization data were analyzed at multivariate regression to predict the occurrence of LV reverse remodeling.</span></span></span></span></span></p> <p style="margin-right:-9px; text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">RESULTS:</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"> Overall, at pre-operative CMR: </span></span></span><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif">mean LV indexed mass (LVMi): 82±28.9g/m<sup>2</sup>; mean end-diastolic LV indexed volume (LVEDVi): 87.4<span style="color:black">±26.6 mL/</span>m<sup>2</sup>; mean geometric remodeling (LV mass/end-diastolic volume): 0.92<span style="color:black">±0.2g/mL. After AVR, at echocardiographic evaluation, no patient had prosthetic obstruction or prosthetic patient mismatch: median LV-Ao gradient 12mmHg [9.1–14mmHg]; 5 of them had mild paravalvular regurgitation. LV reverse remodeling occurred in 65 patients (88%) (Figure 1A) and these were younger, had significantly smaller preoperative AVAi and higher valvular gradients (Figure 1B). At multivariate analysis, only preoperative AVAi remained an independent predictor (odds ratio 0.85, 95% CI 0.735 – 0.984, p=0.029).</span></span></span></span></span></span></p> <p style="margin-right:-9px; text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">CONCLUSIONS: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">In this prospective cohort of patients LV reverse remodeling after surgical AVR was highly frequent, occurring in almost nine out of every ten patients.</span></span></span></span></span></span></p>
Slides
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