Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study

Autores da FMUP

• Jennifer Mâncio Silva

  Autor

• Ricardo José Araújo Ladeiras Lopes

  Autor

• Joaquim Adelino Correia Ferreira Leite Moreira

  Autor

• Nuno Teodoro V. Reis Bettencourt Sousa

  Autor

Participantes de fora da FMUP

• Azevedo, D
• Pessoa Amorim, G
• Monteiro, D
• Almeida, N
• Faria, R
• Ferreira, N
• Vouga, L
• Ribeiro, VG

Unidades de investigação

• Cirurgia e Fisiologia

• Laboratório Associado RISE- Rede de Investigação em Saúde

  

  Investigador

  Fernando Carlos De Landér Schmitt

• RISE-Health

  

  Investigador

  Fernando Carlos De Landér Schmitt

Abstract

Introduction and objectives: In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. Methods: We included 39 severe AS patients (69.3 +/- 7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm(2) (IQR: 0.2) pre- to 1.8 cm(2) (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using tine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. Results: At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e', tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to -13.7% (IQR: 4.62)] and GCS [-17.8 +/- 3.58% to -16.1 +/- 2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e' velocity increased. Conclusions: Despite favorable reverse LV structural and diastolic functional remodeling six months following AVR, GLS and GCS assessed by CMR reduced compared to baseline, LVEF remained unchanged. The clinical utility and timing of assessment of postoperative strain changes as a marker of systolic function progression needs further research. (C) 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espana, S.L.U.

Keywords

• Aortic valve replacement; Left ventricular ejection fraction; Global radial; longitudinal and circumferential strain; Systolic function