SPC365

Predictors of Left Ventricular Hypertrophy at Long-term Follow-up After Effective Stent Implantation For Aortic Coarctation

Session: Posters (Sessão 3 - Écran 7) - Intervenção em cardiopatias congénitas
Speaker: Isabel Sampaio Graca

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.4 Congenital Heart Disease – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Isabel Sampaio Graça; João Rato; Maria Ana Estevens; Miguel Mata; Susana Cordeiro; Mafalda Sequeira; Rui Anjos

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">Background and Aim:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black"> Left ventricular hypertrophy (LVH), defined echocardiographically as an increased LV mass index (LVMI), is a well-established risk factor for cardiovascular mortality and morbidity, as well as a marker for arterial hypertension-mediated organ damage. We evaluated LV mass at long-term follow up of effectively stented aortic coarctation patients, assessing possible targets to decrease this risk factor.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">Methods:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">&nbsp;Study population included 86 patients with aortic coarctation and no significant aortic valve disease, who had undergone stent implantation, with a follow up of 2 to 24 years (mean 11.5 years). Evaluation included clinical data, transthoracic echocardiogram, office blood pressure (BP), 24-hour BP monitoring. LV mass was measured echocardiographically as per published guidelines and indexed to body surface area. Simple linear regression was used to assess correlations for LV mass. Significant variables were used to build a multivariable model.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">Results:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">&nbsp;At the time of stenting, 59 patients (69%) had native coarctation; mean age was 29 years (SD 15.5); 42% had bicuspid aortic valve. </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">Invasive aortic gradient decreased from mean 42.3mmHg (SD 21.2) to 4.7mmHg (SD 6.5) immediately after stenting. There were no major complications.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">At last follow-up: mean age was 40.5 (SD </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">15.5</span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">) and 12% were over 60 years old; all patients had an </span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">echocardiographic isthmic gradient of less than 20mmHg, mean 12.2mmHg (SD 4.8). Fifty-two (60%) patients were on anti-hypertensive medication. Mean systolic office BP was 132mmHg (SD 11.1); and at 24-hour monitoring was 125mmHg (SD 17.9). Mean LVMI decreased from 129.7g/m<sup>2</sup> (SD 53.6) at time of stenting, to</span></span></span> <span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">105.6g/m<sup>2</sup> (SD 31.9) at last follow-up and &nbsp;36% had criteria for LVH. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">The</span></span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black"> multivariable regression model predicted high LVMI using age at first stenting procedure (p&lt;0.001), mean systolic BP at 24-hour Ambulatory BP Monitoring (p=0.005) and male gender (p=0.007).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">Conclusions:</span></span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Helvetica&quot;,sans-serif"><span style="color:black">&nbsp;Despite an effective stenting procedure, patients with aortic coarctation may still have elevated LVMI at long-term follow up. Early identification and treatment of the disease is key to reduce this burden, while 24-hour BP monitoring is the single best exam to predict LVMI, and should be used to guide treatment.</span></span></span></span></span></span></p>