P789 Reverse left atrial functional remodeling after surgical aortic valve replacement is dependent on impaired left atrial function and reverse left ventricular remodeling

Abstract

Abstract Funding Acknowledgements Fundação Portuguesa para a Ciência e Tecnologia (SFRH/BD/104369/2014) and Sociedade Portuguesa de Cardiologia (“Bolsa de investigação João Porto”) OnBehalf EPICHEART Study Background Left atrial (LA) functional remodeling is an important mechanism in the pathophysiology of aortic stenosis (AS), and readily-assessable using speckle-tracking echocardiography (STE). It is uncertain whether and how surgical aortic valve replacement (SAVR) affects reverse LA functional remodeling. Aims We aimed to evaluate LA functional remodeling post-SAVR using STE and to explore potential underlying mechanisms. Methods 73 symptomatic severe AS patients (72.6 ± 8.14 years, 53.4% male) were assessed before and six months after SAVR (Fig.1-A). LA function was evaluated using STE-derived LA longitudinal strain during reservoir (LASr), conduit (LAScd) and contraction (LASct) phases (Fig1.-B); reverse LA remodeling was represented by their relative percentual changes. LA structure was assessed by LA area and indexed volume. Results LA structure and left ventricle (LV) indexed mass, end-diastolic diameter (LVEDD) and mean E/e" improved after SAVR (Table 1). Although paired-samples analysis did not show significant changes in LA function, multiple linear regression revealed that preoperative LA strain parameters were the sole baseline predictors of reverse LA remodeling: lower baseline LASr, LAScd and LASct were related to improved LASr, LAScd and LASct, respectively (Fig.1-C); mean E/e’ decrease was associated with LAScd improvement (Fig.1-D2). LV mass and LVEDD decrease were not associated with LA functional recovery. Conclusion Reverse LA functional remodeling is compromised after SAVR, and increased in patients with impaired baseline LA function. LV diastolic function recovery was linked to improved LA conduit function. An optimal echocardiographic cut-off should be further explored in order to better adjudicate surgical timing, and foster LA functional recovery. Echocardiographic assessment Baseline 6-months post-SAVR Paired t-test (p-value) Mean aortic gradient (mmHg) 49.6 ± 12.2 11.2 ± 5.1 <0.0001 LA area (cm2) 20.9 ± 4.9 19.5 ± 4.1 0.02 LA indexed volume (mL/m2) 37.4 ± 12.4 30.7 ± 8.3 <0.0001 LASr (%) 30.0 ± 10.4 29.3 ± 11.2 0.57 LAScd (%) 14.3 ± 7.4 14.3 ± 6.8 0.95 LASct (%) 15.6 ± 6.5 15.0 ± 7.2 0.50 LV indexed mass (g/m2) 128.6 ± 31.8 124.5 ± 30.0 <0.0001 LV end-diastolic diameter (mm) 45.7 ± 5.19 44.7 ± 5.7 0.03 LV ejection fraction (%) 66.0 ± 6.0 64.6 ± 5.5 0.54 Mean E/e´ ratio 14.2 ± 5.5 11.2 ± 4.3 0.0004 Values are mean ± SD Abstract P789 Figure. Left atrial remodeling after SAVR