RF14 CONSEQUENCES OF PRESSURE OVERLOAD AS DETECTED BY LEFT ATRIAL AND VENTRICULAR STRAIN IN PATIENTS WITH SEVERE AORTIC STENOSIS

Abstract

Background: Severe aortic stenosis (AS) exposes the left ventricle (LV) to an increased afterload, leading to concentric remodelling and subsequent diastolic dysfunction (DD). Fibrosis is the histological key feature. However, none of the conventional echocardiographic parameters is able to reveal the extent of LV remodelling. Aim: to evaluate the ability of speckle tracking echocardiography in detecting LV remodelling in AS patients. Methods: patients undergoing aortic valve replacement (AVR) for severe symptomatic AS were prospectively enrolled. Standard transthoracic echocardiography was performed before surgery. Global LV longitudinal and circumferential strain (GLS, GCS), peak atrial longitudinal and contraction strain (PALS, PACS) were measured. LV septal biopsies to assess fibrosis were performed during surgery. Results: Forty-three consecutive patients were enrolled, with a mean age 73 ± 6years, 58% female. Ejection fraction (EF) 61 ± 7%, aortic valve area (AVA) 0.72 ± 18 cm2, mean gradient (MG) 51 ± 14 mmHg. LV fibrosis was 22 ± 11%. Global longitudinal strain (GLS) 15 ± 4%, peak atrial longitudinal strain (PALS) 24 ± 6%, peak atrial contraction strain (PACS) 12 ± 4%. The only parameters associated with LV fibrosis were MG (r = 0.45, p = 0.004), GLS (r = 0.37, p = 0.02), PALS (r = 0.43, p = 0.004) and PACS (r = 0.35, p = 0.02). After adjusting for GLS and MG, PALS (p = 0.01) and PACS (p = 0.02) were independent predictors of LV fibrosis. The combination of PALS and GLS was the strongest predictor of LV fibrosis. Conclusions: speckle tracking echocardiography provides additional information to characterise the LV remodelling over conventional parameters. Our findings suggest that consequences of pressure overload in AS impact both on ventricular and atrial function, possibly acting through different pathophysiological mechanisms.