Author + information
- Karla Balderas,
- Hugo Rodriguez Zanella,
- Juan Francisco Fritche-Salazar,
- Antonio Jordan-Rios,
- Nydia Avila Vanzzini,
- Luis Eduardo Juarez-Orozco,
- Jose Antonio Arias-Godinez,
- Eduardo Bucio-Reta,
- Oscar Calvillo Argüelles,
- Beatriz Dominguez,
- Manuel Gaxiola and
- Marco Martinez-Rios
Background: Severe aortic stenosis (AoS) represents a common entity for which surgical aortic valve replacement (SAVR) remains the treatment of choice. Low cardiac output syndrome after SAVR is related with increased mortality and treatment related costs. Recently strain imaging has been shown to be useful for prognosis in AoS, and its value remains beyond left ventricular ejection fraction. However its role for predicting low cardiac output syndrome (LCOS) has not been previously assessed. The aim of the present study was to evaluate whether echocardiography-derived right ventricle free wall strain (RVFWS) predicts the occurrence of postoperative LCOS in patients undergoing SAVR.
Methods: We prospectively enrolled patients with symptomatic severe aortic stenosis with LVEF > 30%, NYHA Class I and II, without other significant valvular lesion. A complete echocardiographic examination was performed before SAVR. Right ventricle free wall strain was measured in all patients before surgery. Patients were followed up during hospital stay. The main outcome was the occurrence of LCOS.
Results: A total 32 patients were included. Baseline clinical characteristics were similar between groups. RVFWS was significantly lower in patients with LCOS than in patients without LCOS (12.8±4.3 vs. -17.1±3.9) before surgery and it was independently associated to the occurrence of low cardiac output [p=0.005]. ROC curves to evaluate the utility of RV free wall strain to predict LCOS occurrence yielded a sensitivity of 81.2% and specificity of 71.4%, +LR of 2.86 of and -LR of 0.25 for a cut-off point of -15.
Conclusions: Right ventricle free wall strain is a useful parameter for risk stratification in patients with Sever AoS without severely depressed LVEF, and is independently associated with LCOS occurrence. The role of right ventricle in the genesis of LCOS is never contemplated and could explain its development in patients with preserved LVEF. This is an open field to extend research.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: The Challenges of Outcome Prediction in Valvular Heart Disease
Abstract Category: 37. Valvular Heart Disease: Therapy
Presentation Number: 1274-029
- 2017 American College of Cardiology Foundation