SPC365

Should contractile reserve be a decisive factor on severe aortic valve intervention?

Session: Posters (Sessão 2 - Écran 8) - Doença Valvular 2 - Foco no Ecocardiograma na Válvula Aórtica
Speaker: Catarina Gregório

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Catarina Gregório; Sara Couto Pereira; Joana Rigueira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Susana Gonçalves; Daniel Caldeira; Rui Plácido; Fausto j. Pinto; Ana g. Almeida

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Stress echocardiography (SE) is a key exam for the assessment of the real severity of aortic stenosis (AS) in patients (pts) with left ventricular dysfunction. The presence of contractile reserve (CR) allows the diagnosis of severe AS in low-flow low-gradient (LFLG) pts and may play a role in the decision for aortic valvular intervention (AVI).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Our aim</strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> is to evaluate the prognostic value of CR in pts submitted to VI, either surgical (SAVR) or percutaneous (TAVI).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Retrospective, single-center study of consecutive pts with moderate to severe LFLG AS (mean transvalvular gradient &lt;40 mmHg, LVEF &lt; 50%, indexed stroke volume (SVi) &lt;=35 mL/m</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> and an aortic valve area (AVA) &lt;=1 cm</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>2</sup></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">) submitted to SE.&nbsp; Epidemiologic, clinical and echocardiographic data were recorded.&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Pts were stratified by the presence CR (increase in SVi&ge;20% during SE) and AVI after SE. All-cause mortality and HF hospitalizations during a pre-determined follow up period (FUP) of 3 years were recorded. Survival analysis was performed using Kaplan-Meier curves.&nbsp;&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Between January 2014 and June 2021, 57 pts were submitted to SE (exercise in 22(38.6%) and dobutamine in 35(61.4%) pts). 40 (70.2%) pts were males, with a mean age of 75.6&plusmn;8.5 years. At baseline, 48 (84.2%) pts had hypertension, 42 (73.7%) had dyslipidemia, 28 (49.1%) were diabetic and 28 (49.1%) had coronary arterial disease (CAD). Most of the pts were at NYHA functional class II (34, 59.6%). At SE, CR was present in 39 (68.4%) pts.&nbsp;&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">AVI was performed in 26(41.3%) pts, 21 of which had CR on SE. Valvular intervention was SAVR for 12 pts and TAVI for 14 pts. During a mean FUP of 3 years, 9 pts in the AVI group and 21 pts in non-AVI group died, respectively.&nbsp; &nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In pts submitted to AVI, survival was independent of the presence of CR (p = 0.916). On another hand, in patients not submitted to AVI the presence of CR was associated with worse prognosis, although not statistically significant (p= 0.122).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In this small single-center study we observed that CR assessment by SE shouldn&rsquo;t define the indication for valvular intervention in patients with severe AS, for it didn&rsquo;t correlate with survival. Larger studies are necessary to confirm these results.</span></span></span></p>