Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study |
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Authors: | Diana Azevedo Jennifer Mancio Guilherme Pessoa-Amorim David Monteiro Nuno Almeida Ricardo Ladeiras-Lopes Rita Faria Nuno Ferreira Luís Vouga Vasco Gama Ribeiro Adelino Leite-Moreira Nuno Bettencourt |
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Affiliation: | 1. Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal;2. Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal;3. Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal;4. Department of Cardiothoracic Surgery, Centro Hospitalar de São João, Portugal |
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Abstract: | Introduction and objectivesIn 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.MethodsWe 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 cm2 (IQR: 0.2) pre- to 1.8 cm2 (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 cine 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.ResultsAt 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.ConclusionsDespite 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. |
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Keywords: | Aortic valve replacement Left ventricular ejection fraction Global radial longitudinal and circumferential strain Systolic function Substituição da válvula aórtica Fração de ejeção do ventrículo esquerdo Função sistólica |
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