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aortic stenosis. the role of aortoseptal angulation as a predictive factor for asymmetrical septal hypertrophy.
1Barts Health NHS Trust - London - United Kingdom of Great Britain & Northern Ireland
2University College London - London - United Kingdom of Great Britain & Northern Ireland
Topic(s): Cardiac Magnetic Resonance: Valve Disease
Intro: Aortic stenosis (AS) results in increased left ventricular (LV) pressure results in left ventricular hypertrophy (LVH), which regresses after aortic valve replacement (AVR). The LV remodels in a variety of patterns and degrees, and can be asymmetrical in a quarter of patients with asymmetric septal hypertrophy (ASH). The aortoseptal angulation (ASA) has shown to be more acute in patients with LVH, and may be associated to the degree of ASH.
Purpose: To evaluate the role of ASA in AS, hypothesising that ASH is associated with a more acute angulation and may regress after AVR,
Methods: Patients with severe AS from the RELIEF-AS Study (NCT 02174471) with paired CMRs before and 1-year after surgical AVR were included. CMR analysis was performed on bSSFP cine images in short and long axes images using CVI42 (Circle Version 5.2, Canada). ASA was defined as the angle between a line drawn along the border of the right and left intraventricular septum (parallel to the proximal RV endocardial border) and a line drawn through the long axis of the aortic root (see Figure 1).
Results: 116 patients with symptomatic severe AS were included in the analysis (Age, 70±10 years, 55% male, aortic valve area 0.66±cm2±0.02cm2, 94% of the cohort were hypertensive and 18% were diabetic).
Pre-AVR: ASH was associated with patient sex (ß=0.229), weight (ß=0.222), BMI (ß=0.160), aortic annulus area (ß=0.243), aortic valve area (ß=0.178) and ASA (ß=-0.261), (p<0.05). On multivariate analysis, only aortic valve area was significant (ß= 0.030, p<0.05).
ASA was associated with patient sex (ß=-0.250), aortic diameter (ß=-0.287) and maximal septal wall thickness (ß=-0.261), (p<0.05). On multivariate analysis, aortic diameter and septal hypertrophy were the associations (p<0.05), although sex showed a trend in the results (p=0.072).
At 1-year post-AVR, there was an association between the angle increase and normalisation of the ASH (p<0.0001).
Conclusion: In severe aortic stenosis, asymmetrical septal hypertrophy is associated with the acuteness of the aorto-septal angle with both increasing post-operatively.