SPC365

LV reverse remodeling after SAVR in patients with severe symptomatic aortic stenosis: impact on the clinical outcome

Session: Best Posters
Speaker: Maria Rita Giestas Lima

Congress: CPC 2024
Topic: B. Imaging
Theme: 03. Imaging
Subtheme: 03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type: Cartazes
FP Number: ---
Authors: Maria Rita Giestas Lima; João Abecasis; Rita Reis Santos; Sérgio Maltês; Sara Guerreiro; Pedro Freitas; António Ferreira; Regina Ribeiras; Maria João Andrade; Miguel Sousa-Uva; Pedro Adragão

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Surgical aortic valve replacement (SAVR) is the treatment of choice for young patients with severe aortic stenosis (AS) and low surgical risk.</span> <span style="font-family:&quot;Times New Roman&quot;,serif">Left ventricular (LV) reverse remodeling (RR) after surgery is expected to occur. However, this is not always the case following afterload relief, and this may impact the prognosis. We aimed to assess the prognostic effect of distinct definitions of LV RR after SAVR in the long-term outcome of patients with severe AS.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">Single-centre prospective study including patients referred for SAVR due to severe symptomatic AS, with no previous history of ischemic cardiomyopathy. Both pre- and post-operative transthoracic echocardiographic (TTE) and cardiac magnetic resonance (CMR) study (at the 3rd to 6th month after SAVR) were performed. LV RR was defined when in presence of at least one of the imaging criteria: &gt;15% decrease in end-diastolic volume (EDV) by CMR; &gt;15% decrease in LV indexed mass (LVM) by CMR; &gt;10% decrease in geometric remodeling (LV mass/EDV ratio) by CMR; &gt;10% increase in LV ejection fraction (LVEF) by CMR; &gt;50% increase on global longitudinal strain (GLS) by TTE. We assess the prognostic value of RR definitions for the outcome after SAVR using Cox regression and Kaplan-Meier analysis. The primary endpoint was defined as all-cause mortality, heart failure (HF) hospitalization or worsening HF.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">We enrolled 140 patients &ndash; mean age </span><span style="font-family:&quot;Times New Roman&quot;,serif">71&plusmn;9 years-old, 49% male, predominantly high-gradient-normal flow AS (mean gradient 65&plusmn;18mmHg, aortic valve area 0.7&plusmn;0.2cm<sup>2</sup>, index stroke volume 47&plusmn;11mL/m<sup>2</sup>) submitted to SAVR</span><span style="font-family:&quot;Times New Roman&quot;,serif">. At a mean follow-up (FUP) of </span><span style="font-family:&quot;Times New Roman&quot;,serif">34&plusmn;12 months, </span><span style="font-family:&quot;Times New Roman&quot;,serif">23 (16%) patients met the primary endpoint: 4% (5 patients) died immediately after surgery; three patients died at the FUP (overall mortality rate of 6%). 12 patients (9%) were admitted for HF and 7 (5%) had at least one episode of worsening HF. 118 patients had complete pre and post-surgery imaging study (mean FUP: </span><span style="font-family:&quot;Times New Roman&quot;,serif">36&plusmn;10 months)</span><span style="font-family:&quot;Times New Roman&quot;,serif">: 103 patients (87%) had at least one RR parameter (Table 1). Post-operative RR was not independently associated with the clinical outcome (Figure 1A). LVM was the sole independent predictor of the outcome at univariate analysis (Figure 1B&ndash;F).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:&quot;Times New Roman&quot;,serif">LV RR after SAVR is highly prevalent in a cohort of patients with classical severe symptomatic AS. However, only LVM regression independently predicts the clinical outcome after surgery. This may stand the greater importance of structural reverse remodeling, rather than LV functional improvement, after pressure overload relief.</span></span></span></p>