SPC365

Left ventricular dysfunction in patients with aortic stenosis

Session: Comunicações Orais - Sessão 02 - Doença aórtica
Speaker: Inês Rodrigues

Congress: CPC 2024
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.7 Valvular Heart Disease - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Inês Rodrigues; Rafael Teixeira; António Gonçalves; Fábio Nunes; Marta Leite; Inês Neves; Ricardo Fontes Carvalho

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Background</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Chronic pressure overload imposed by aortic stenosis (AS) may result in </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Left ventricle (LV) </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">systolic dysfunction. Since reduced LV ejection fraction (LVEF) is associated with poor outcomes in patients with severe AS even after aortic valve replacement (AVR), the ideal time for AVR is before LVEF deterioration. However, the exact moment when LVEF declines and a clear cut-off for an abnormal LVEF in patients with severe AS is not well studied. </span></span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Aim</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">:&nbsp;We aim to </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">compare </span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">the longitudinal changes in LVEF and aortic valve area (AVA) in patients with severe AS and their impact on prognosis. </span></span></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">:&nbsp;</span></span> <span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Patients with AVA &le; 1cm<sup>2 </sup>, under normal flow conditions, recorded on transthoracic echocardiogram and at least one prior exam performed &gt; 1 year before, were </span></span></span><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">retrospectively identified.<span style="color:black"> Moderate to severe aortic or mitral regurgitation and bicuspid aortic valve were excluded. Characteristics of patients with LVEF &lt; 50% versus &ge; 50% at the moment of the diagnosis of severe AS and 1 year before were compared. A multivariate regression model was used to identify predictors of LVEF deterioration. A Cox model was used to assess the impact of LVEF on overall mortality after adjusting for comorbidities and AVR, as a time dependent covariate. </span></span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong>&nbsp;645 patients were included (median follow up of 4 years [IQR= 2.3-6.5], 51% female, age 78 years). When severe AS was first identified, 177 (27%) patients had a LVEF&nbsp;&lt;50% and 468 (73%) had an LVEF &ge; 50%. For patients with LVEF &lt;50%, LVEF deterioration had begun before AS became severe, whereas LVEF remained &gt; 55% in patients with preserved LVEF at initial diagnosis. LVEF &lt; 55 % in the year before predicted LVEF deterioration (adjusted odds ratio= 2.50; 95% CI = 1.81-3.18, p &lt; 0.01). Overall mortality rate was higher in patients with LVEF&lt; 50% (adjusted hazard ratio= 2.88, 95% CI= 2.17-3.70, p&lt;0.001) even after adjusting for time dependent AVR. The relative risk of death steeply increased when LVEF &lt; 55%. </span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Our results suggest that LVEF deterioration may begin before AS becomes severe and higher cut-offs (&gt;55%) may be appropriate to define systolic disfunction in patients with moderate AS. For patients with severe, overall mortality rapidly increases when LVEF &lt; 55%, even after AVR. Further studies are required to establish the benefit of AVR in patients with moderate AS and LVEF &lt;55%. </span></span></p>