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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Mitral regurgitation on low-flow low-gradient severe aortic stenosis and preserved ejection fraction
Session:
Posters (Sessão 4 - Écran 1) - Imagem 2 - Ecocardiografia 1
Speaker:
João Baltazar Ferreira
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
João Baltazar Ferreira; Mariana Passos; Joana Lima Lopes; Carolina Pereira Mateus; Inês Fialho; Marco Beringuilho; António Freitas; Carlos Morais
Abstract
<p>Introduction<br /> According to current guidelines, given a patient whose echocardiographic aortic stenosis evaluation is low-gradient (aortic valve maximum velocity < 4m/s and/or aortic valve mean gradient <40mmHg), low-flow (stroke volume (SV) < 35mL/min/m2), with estimated aortic valve area (AVA) < 1cm2 and preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow.</p> <p>Methods<br /> Retrospective analysis of 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA < 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (< 50%) were excluded. A total of 84 patients were included (females 53,6%, mean age 79,1+-10 years). Antegrade stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). Then, comparisons were made for the prevalence of more than mild mitral regurgitation among patients with both low-gradient and low-flow and the other patients.</p> <p>Results<br /> 15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among those patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In those patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06).</p> <p>Conclusions<br /> Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, these results suggests that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.</p>
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