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Left atrial strain correlates with cardiovascular events in patients with rheumatic mitral stenosi

Session Poster session 6

Speaker Filipa Andreia Castro

Congress : EuroEcho 2018

  • Topic : imaging
  • Sub-topic : Echocardiography: Valve Disease
  • Session type : Poster Session
  • FP Number : P1724

Authors : F A Castro (Guimaraes,PT), O Azevedo (Guimaraes,PT), M Lourenco (Guimaraes,PT), B Faria (Guimaraes,PT), M Oliveira (Guimaraes,PT), M Fernandes (Guimaraes,PT), S Leite (Guimaraes,PT), I Oliveira (Guimaraes,PT), A Lourenco (Guimaraes,PT)

Authors:
F A Castro1 , O Azevedo1 , M Lourenco1 , B Faria1 , M Oliveira1 , M Fernandes1 , S Leite1 , I Oliveira1 , A Lourenco1 , 1Hospital Senhora da Oliveira, Serviço de Cardiologia - Guimarães - Portugal ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 1 ), i1237

Introduction: Left atrial (LA) dysfunction, expressed as impaired LA strain, has been observed in association with rheumatic mitral stenosis (RMS). This pathology carries a high risk of cardiovascular (CV) events and the clinical role of speckle tracking echocardiography – LA strain –has rarely been studied in RMS. The prognostic value of atrial strain parameters is not established in patients with RMS.

Aim: To assess LA function using strain analysis by speckle tracking in patients with RMS. To evaluate the usefulness of LA strain for the prediction of adverse CV events in RMS.

Methods: We included 55 patients with mild to severe RMS, in sinus rhythm. All subjects underwent transthoracic echocardiogram, including evaluation of PALS (Peak atrial longitudinal strain) and PACS (Peak atrial contraction strain) by speckle tracking. PALS was measured at the end of the reservoir phase and PACS was measured just before the start of the active atrial contractile phase. The averages of PALS and PACS were obtained from the 12 LA segments at apical 4 and 2 chamber views. Demographic data, clinical data (including hospitalization for cardiac cause) and electrocardiographic findings were collected to identify predictors of prognosis. The combined endpoint of CV events at 3,3 year follow-up was composed by atrial fibrillation (AF), percutaneous valvuloplasty, mitral valve replacement and pulmonary hypertension (PHT).

Results: Patients were predominantly females (87,3%), with mean age of 59±12 years and presented a low PALS (18,2 ± 7.1%) and PACS (10,6±5.4%).
Hospitalization for cardiac cause occurred in 21,8% of cases.
Mitral valve replacement was performed in 12,7% of cases. PHT developed in 30,9% of patients and AF in 32,7%.
The combined endpoint of CV events occurred in 45,5% of cases. There was a significant decrease of LA strain parameters, PALS and PACS, in patients who present hospitalization for cardiac cause (PALS=14,1% vs 19,3%, p=0,029; PACS=7,5% vs 11,5; p=0,017), PHT (PALS=11,4% vs 21,1%; PACS=6,4% vs 12,4; p<0,001), AF (PALS=13% vs 20,6%; PACS=7% vs 11,9; p=0,000) and the combined endpoint of CV events(PALS=13,7% vs 21,9%, PACS=7,7% vs 13, p=0,000), compared to patients that do not present these events.
Upon multivariate regression analysis, PALS was as an independent predictor of PHT (p=0,027). Mitral valve area by pressure half time method was as an independent predictor of the combined endpoint of CV events (p=0,025).

Conclusion: LA strain parameters, PALS and PACS, were significantly decreased in patients who present hospitalization for cardiac cause, PHT, AF or the combined endpoint of CV events.
In this study, PALS was an important independent predictor of PHT while mitral valve area by pressure half time was an important independent predictor of CV events in patients with RMS.

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