SPC365

Prevalence, management, and prognosis of patients with severe aortic stenosis and reduced ejection fraction

Session: Posters (Sessão 3 - Écran 8) - Doença Valvular 3 - Válvula Aórtica
Speaker: Inês Fialho

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: Inês Fialho; Carolina Pereira Mateus; Mariana Passos; Joana Lima Lopes; João Baltazar Ferreira; David Roque; Márcio Madeira; Daniel Faria; João Bicho Augusto; Miguel Santos; Sérgio Bravo Baptista; Pedro Farto e Abreu; Carlos Morais; José Neves

<p style="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="font-family:Arial,sans-serif"><span style="color:black">Background: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Reduced<strong> </strong></span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">left ventricular ejection fraction (LVEF) is a known undesirable consequence of pressure overload in the natural history of aortic stenosis (AS).</span></span></span></span></span></p>

<p style="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="font-family:Arial,sans-serif">Objective:</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> To evaluate the management and prognosis of patients with severe AS according to LVEF</span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">.</span></span></span></span></span></span></p>

<p style="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="font-family:Arial,sans-serif"><span style="color:black">Methods: </span></span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">Prospective registry<strong> </strong>of consecutive patients discussed in the Heart Team meeting of a single center between January 2018 and June 2021. Patients with severe AS were included. F</span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">or each patient demographics, blood tests results, echocardiogram, treatment decision, and MACEs (a composite of death, heart failure hospitalization, non-fatal acute myocardial infarction and non-fatal stroke) until aortic valve replacement (AVR, surgical or transcatheter) were recorded (median follow-up time 187 days [IQR 59-352].</span></span></span></span></span></p>

<p style="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="font-family:Arial,sans-serif">Results:</span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"> 235 patients were included, 48.1% males (n=113), mean age of 76.7&plusmn;10.7 years. LVEF was reduced (&lt;50%) in 25.1% (n=59). Patients with reduced EF (ASrEF) presented higher EuroSCORE II levels (median 5.28% [interquartile range 3.27-9.02] vs 2.8% [1.8-4.7], p&lt;0.001) compared with AS with preserved EF (ASpEF). The Heart Team decided for AVR in 90.0% (n=53) of ASrEF and 96.0% (n=169) of ASpEF patients. Transcatheter AVR was the most common intervention in ASrEF (52.5%, n=31) and surgical AVR the most frequent in ASpEF (54.0%, n=95). Conservative management was decided for 10% (n=6) of ASrEF and 4% (n=7) of ASpEF patients. ASrEF patients waited less time for AVR [71 (26-230) vs 187 (81-352) days, p= 0.003]. While waiting for AVR, the ASrEF group presented significantly more MACE (Mantel-cox log rank p = 0.035, Figure 1). The early post-operative mortality (first 7 days after surgery) was not different between groups (0% vs 0.6%, p=0.893). Sixty three percent of ASrEF patients improved LVEF after AVR.</span></span></span></span></span></p>

<p style="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="font-family:Arial,sans-serif"><span style="color:black">Conclusion</span></span></span></strong><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">: </span></span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">ASrEF patients present less time to MACE and more cardiovascular events </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">while they wait for AVR. After AVR, most ASrEF patients improves LVEF without an increase in early post-operative mortality. These data suggest that this vulnerable subgroup of AS patients benefit from AVR and as such should be prioritized in the AVR (surgical or transcatheter) waiting lists.</span></span></span></span></span></p>