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Left ventricular mechanics reveals a benign reduction in ejection fraction after valve replacement in aortic stenosis

Session Poster session 2

Speaker Kush Patel

Event : EuroCMR 2019

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

Authors : K Patel (London,GB), RE Bachiller (Madrid,ES), R Boubertakh (London,GB), S Moir (Melbourne,AU), R Kozor (Sydney,AU), R Davies (London,GB), A Bhuva (London,GB), P Scully (London,GB), AS Herrey (London,GB), C Manisty (London,GB), JC Moon (London,GB), TA Treibel (London,GB)

Authors:
K Patel1 , RE Bachiller2 , R Boubertakh1 , S Moir3 , R Kozor4 , R Davies1 , A Bhuva1 , P Scully1 , AS Herrey1 , C Manisty1 , JC Moon1 , TA Treibel1 , 1Barts Health NHS Trust, Cardiac Imaging - London - United Kingdom of Great Britain & Northern Ireland , 2University Hospital La Paz - Madrid - Spain , 3Monash University - Melbourne - Australia , 4University of Sydney - Sydney - Australia ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii346

Introduction 
Aortic stenosis (AS) results in left ventricular (LV) hypertrophy, which regresses after aortic valve replacement (AVR), both accompanied by changes in LV ejection fraction (LVEF).  Strain imaging by CMR feature tracking (CMR-FT) may provide a more sensitive assessment of these alterations. 

Purpose 
To assess LV strain prior to and after AVR in patients with supranormal (EF=75%) and normal/impaired LVEF (EF<75%). 

Methods 
CMR-FT analysis was performed on standard cine images of patients with severe AS, before and 1-year after surgical AVR.

Results
48 patients had EF=75% (age 70±11; 44% male) and 53 had EF<75% (age 69±9; 66% male). At baseline, patients with EF<75% had higher LV mass index (LVMi) and worse LV strain (Table 1) than EF=75%. In EF<75%, strain parameters were strongly correlated with LVEF (R>0.7; p<0.001), however, in EF=75% this relationship was lost (Fig 1). 

1-year post AVR, patients with EF=75% had lower LVMi regression and a reduction in LVEF compared to EF<75%. Whereas LV strain parameters and NT-proBNP levels improved in patients with EF<75%, they remained unchanged in EF=75% (Table 1).

Conclusion
Supra-normal LVEF in AS patients reduces post-operatively with LV strain and NT-proBNP confirming that this is a benign normalisation.

Baseline LVEF<75% (n=53) LVEF≥75% (n=48) P value
LVMi 99.3±27.7 78.1±19.5 <0.001
LVEF 60.6±14.7 82.5±4.1 <0.001
CS -14.8±5.3 -22.0±3.8 <0.001
RS 27.5±13.1 47.7±13.8 <0.001
LS -14.8±5.3 -19.8±4.0 <0.001
NT-proBNP 145 (49 to 425) 30 (18 to 51) <0.001
1 year
Change in LVMi -22.2±18.6 -13.8±5.3 0.007
Change in LVEF 9.1±15.2 -3.1±5.3 <0.001
Change in CS -4.0±5.8 0.0±4.4 <0.001
Change in RS 11.8±16.7 4.4±19.2 0.044
Change in LS -3.6±5.8 -1.9±6.2 0.173
Change in NT-proBNP -50 (-378 to -12) 0 (-11 to 23) <0.001
Remodelling and functional parameters in EF<75% and EF=75%. LVMi- left ventricular mass index, LVEF- left ventricular ejection fraction, CS- circumferential strain, RS- radial strain, LS- longitudinal strain, NT-proBNP- N-terminal pro-brain natriuretic peptide.

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