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Prognostic value of proximal aorta longitudinal strain for aortic events and dilation in Marfan syndrome patients

Session Poster session 2

Speaker Andrea Guala

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance
  • Session type : Poster Session

Authors : A Guala (Barcelona,ES), JF Rodriguez-Palomares (Barcelona,ES), A Ruiz Munoz (Barcelona,ES), L Dux-Santoy (Barcelona,ES), N Villalva (Barcelona,ES), C Granato (Barcelona,ES), L Galian (Barcelona,ES), L Gutierrez (Barcelona,ES), T Gonzalez-Alujas (Barcelona,ES), M Gandara (Barcelona,ES), V Sanchez (Madrid,ES), A Forteza (Madrid,ES), D Garcia-Dorado (Barcelona,ES), A Evangelista (Barcelona,ES), G Teixido Tura (Barcelona,ES)

Authors:
A Guala1 , JF Rodriguez-Palomares1 , A Ruiz Munoz1 , L Dux-Santoy1 , N Villalva1 , C Granato1 , L Galian1 , L Gutierrez1 , T Gonzalez-Alujas1 , M Gandara1 , V Sanchez2 , A Forteza3 , D Garcia-Dorado1 , A Evangelista1 , G Teixido Tura1 , 1University Hospital Vall d'Hebron, Department of Cardiology - Barcelona - Spain , 2University Hospital 12 de Octubre - Madrid - Spain , 3University Hospital Puerta de Hierro Majadahonda - Madrid - Spain ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii323

BACKGROUND
Aortic root dilation and type A aortic dissection are the most common cardiovascular complications of Marfan syndrome (MFS) patients. In clinical practice, MFS patients are closely followed up for aortic root dilation. Current guidelines support the use of aortic diameter to indicate preventive aortic root surgery, which is indicated if diameter reaches a threshold or in case of fast-progressing dilation. However, the predictive capacity of diameter is limited, given that a large part of acute aortic events happen in aorta with a diameter lower than the suggested threshold. New non-invasive biomarkers to improve risk stratification are thus needed.

PURPOSE
We aimed to evaluate whether proximal aorta circumferential and longitudinal strain and ascending aorta distensibility predict aortic root diameter growth and incidence of aortic events in Marfan patients.

METHODS
Eighty seven Marfan patients, diagnosed by original Ghent criteria and free from previous cardiac/aortic surgery or dissection, were prospectively included in a multicenter follow-up. Proximal aorta longitudinal and circumferential strain and distensibility were computed from baseline cine CMR images.

RESULTS
During a follow-up of 81.6 ± 17 months, mean diameter and z-score growth-rates were 0.65 ± 0.67 mm/year and 0.07 ± 0.13 1/year, respectively. Two patients presented type A aortic dissection while 11 required elective aortic root replacement. Proximal aorta longitudinal strain but not circumferential strain and distensibility were independent predictors of diameter growth-rate (p=0.001, p=0.385 and p=0.381, respectively), z-score growth-rate (p=0.018, p=0.515 and p=0.484, respectively) and aortic events (p=0.018, p=0.064 and p=0.205, respectively), in multivariable analyses corrected for demographic and clinical characteristics, including baseline aortic root diameter.

CONCLUSIONS
In Marfan syndrome patients, proximal aorta longitudinal strain independently predicts aortic root dilation and major aortic events beyond aortic root diameter and clinical risk factors

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