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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Left atrial and left ventricular strain imaging evaluation of heart failure with reduced ejection fraction patients under sacubitril/valsartan: atrial fibrillation substudy
Session:
Comunicações Orais - Sessão 27 - Ecocardiografia
Speaker:
Pedro Brás
Congress:
CPC 2023
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Pedro Garcia Brás; António Valentim Gonçalves; Rita Ilhão Moreira; Tiago Pereira da Silva; Luísa Moura Branco; Pedro Rio; Tânia Mano; João Reis; Alexandra Castelo; Vera Ferreira; Isabel Cardoso; Ana Teresa Timóteo; João Abreu; Rui Cruz Ferreira
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Background: While sacubitril/valsartan (SV) is increasingly used in heart failure with reduced ejection fraction (HF), data is limited regarding its improvement in left atrial (LA) and left ventricular (LV) strain parameters, particularly in patients (P) with atrial fibrillation (AF). Our aim was to evaluate the difference in LA and LV strain before and after 6 months of SV therapy in HF P in sinus rhythm (SR) and in AF. </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Methods: Prospective evaluation of HF P under optimized guideline-directed medical therapy. LA and LV parameters were assessed by 2D speckle-tracking at baseline and after 6 months of SV therapy. LA reservoir strain (LASr), conduit strain (LAScd) and respective phases’ strain rate (StR) as well as LV longitudinal, radial and circumferential (circ) strain (Fig 1) and respective StR were evaluated in SR P and AF P vs baseline. </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Results: 35 P, mean age 59±11 years, 83% male and 40% in AF. There was a significant improvement in LASr (13.85±5.9% vs 19.78±6.5%, p<0.001), LAScd (-6.00 [-8.26–-4.38]% vs -7.25 [-10.84–-4.75]%, p=0.024) and reservoir StR (0.54±0.20 s<sup>-1</sup> vs 0.74±0.15 s<sup>-1</sup>, p=0.001) with SV therapy vs baseline in SR P. Although there was a trend to improvement in AF P, it was not statistically significant: LASr (7.00±3.64% vs 9.04±4.5%, p=0.08), LAScd (-6.25 [-10.78–-3.91]% vs -7.35 [-14.38–-5.26]%, p=0.056), reservoir StR (0.38±0.23 s<sup>-1</sup> vs 0.46±0.24 s<sup>-1</sup>, p=0.135) and conduit StR (-0.34 [-0.6–-0.27] s<sup>-1</sup> vs -0.42 [-0.72–-0.34] s<sup>-1</sup>, p=0.09). </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Results were similar concerning longitudinal LV function in SR P: Peak longitudinal strain (-6.12±1.97% vs -9.98±2.60%, p<0.001), systolic strain rate (StRs) (-0.32±0.11 s<sup>-1</sup> vs -0.50±0.12 s<sup>-1</sup>, p<0.001), early diastolic strain rate (StRe) (0.24 [0.17–0.41] s<sup>-1</sup> vs 0.50 [0.27–0.65] s<sup>-1</sup>, p=0.001). AF P improved peak longitudinal strain (-4.48±1.68% vs -7.79±2.33%, p<0.001) and StRe (0.27 [0.20–0.41] s<sup>-1</sup> vs 0.44 [0.25–0.52] s<sup>-1</sup>, p=0.014). Regarding radial function there was significant improvement in SR P: peak radial strain (5.87 [4.89–9.43]% vs 11.28 [7.64–14.28]%, p=0.001), StRs (0.68±0.25 s<sup>-1</sup> vs 0.95±0.3 s<sup>-1</sup>, p=0.002) and StRe (-0.66±0.31 s<sup>-1</sup> vs -1.1±0.62 s<sup>-1</sup>, p=0.005). In AF P while peak radial strain significantly improved (5.22 [3.98–9.21]% vs 12.85 [8.77–14.85]%, p=0.005), there was no improvement in StRs and StRe. Circ function was significantly higher compared to baseline in SR P: peak circ strain (-7.49±2.3% vs -10.68±2.4%, p<0.001), StRs (-0.79 [-1.1–-0.62] s<sup>-1</sup> vs -0.98 [-1.25–-0.77] s<sup>-1</sup>, p=0.009) and StRe (0.84±0.26 s<sup>-1</sup> vs 0.98±0.23 s<sup>-1</sup>, p=0.025) while AF P did not significantly improve peak circ strain (-8.0±2.4% vs -8.22±1.72%, p=0.855), StRs or StRe. </span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">Conclusion: After 6 months of SV therapy there was a significant improvement in LA and global LV strain parameters in SR P and peak longitudinal and radial strain in AF P. These findings suggest that SV may have a higher effect in reverse LA and LV remodeling in P in SR compared to P in AF.</span></span></p>
Slides
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