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Cardiac damage extent in patient with isolated severe aortic stenosis referred to surgical aortic valve replacement: is it reversible after surgery?
Session:
Comunicações Orais - Sessão 28 - Doença Valvular e Endocardite
Speaker:
Sérgio Maltês
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.8 Infective Endocarditis - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; João Abecasis; Rita Reis Santos; Maria Rita Lima; Sara Guerreiro; Telma Lima; Pedro Freitas; Regina Ribeiras; Maria João Andrade; José Pedro Neves; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Aortic stenosis (AS) may lead to progressive and adverse cardiac remodeling. A recently proposed staging classification regarding extravalvular cardiac damage in AS patients undergoing aortic valve intervention was shown to have significant prognosis implications. However, cardiac damage evolution and reversibility after intervention remain unknown. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Aims</u>: to assess extravalvular cardiac damage evolution after surgical aortic valve replacement (SAVR) in patients with isolated severe AS. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methodology</u><span style="color:#222222">: we performed a single-center, prospective cohort study enrolling consecutive patients with severe AS undergoing SAVR. Those with previous cardiomyopathy or concomitant severe valve dysfunction beyond AS were excluded. All patients performed transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) within 3 months before SAVR as well as at the 3<sup>rd</sup> to 6<sup>th</sup> post-operative month. Patients were classified according to the extent of cardiac damage into 4 groups: stage 0: no damage; stage 1: left ventricle (LV) hypertrophy (indexed LV mass >95 g/m<sup>2</sup> [women] or >115 g/m<sup>2</sup> [men]), LV diastolic (E/e′ > 14) or systolic (ejection fraction <50%) dysfunction; stage 2: dilated left atrium (>34mL/m<sup>2</sup>) or atrial fibrillation; stage 3: pulmonary hypertension (systolic pulmonary artery pressure ≥60mmHg); stage 4: significant right ventricle (RV) dysfunction. Global longitudinal strain (GLS) was also assessed to further characterize the extent of LV damage – a GLS > -14.7% was considered abnormal. Due to the impact of on-pump cardiac surgery on RV systolic longitudinal function, RV ejection fraction assessed by CMR (<45%) was used to define significant post-operative RV dysfunction. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: A total of 67 patients were included (mean age 71 ± 8 years; 50% male; mean valvular transaortic gradient 60 ± 19 mmHg; mean indexed aortic valve area 0.4 ± 0.01 cm<sup>2</sup>/m<sup>2</sup>; mean LV ejection fraction by TTE 58 ± 9%). Overall, a significant number of patients still showed some sign of structural cardiac damage after surgery – 14 vs. 10 on stage 1, 44 vs. 39 on stage 2, 1 vs. 1 on stage 3 and 4 vs. 4 patients on stage 4 after SAVR- <strong>figure 1</strong>. However, a statistically significant improvement in the number of patients at stage 0 after surgery (4 vs. 11, paired McNemar test p=0.016) was observed, as well as a significant improvement in GLS (mean GLS pre and post AVR -14.8 ± 3.6% vs. -16.6 ± 3.3%, respectively; 45 vs. 21% patients with abnormal GLS before and after AVR, p=0.001). </span></span></span></p> <p><u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#222222">Conclusion:</span></span></span></u><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif"><span style="color:#222222"> Extravalvular cardiac damage is common in a selected cohort of severe AS patients and potentially reversible after SAVR. A significant improvement in GLS was observed after surgery, suggesting that longitudinal strain may be afterload dependent and amenable for improvement post-AVR.</span></span></span></p>
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