Florentina Petillo

The Utility of Flow Rate Compared with Left Ventricular Stroke Volume Index in the Hemodynamic Classification of Severe Aortic Stenosis with Preserved Ejection Fraction

Objectives: To substitute the stroke volume index (SVi) with flow rate (FR) in the hemodynamic classification of severe aortic stenosis (AS) with preserved ejection fraction (EF), in order to evaluate its prognostic value. Methods: A total of 529 patients (78.8 ± 9.8 years old, 44.1% males) with isolated severe AS (aortic valve area, AVA < 1 cm²), EF ≥50%, in sinus rhythm, who underwent transthoracic echocardiography, were stratified by FR (≥/< 200 mL/s) and mean pressure gradient (MG) (≥/< 40 mm Hg): FR_normal/MG_high, FR_low/MG_high, FR_normal/MG_low, and FR_low/MG_low. Results: Aortic valve replacement was more frequently performed in the FR_normal/MG_high than in the FR_low/MG_low group (69.3 vs. 47%, respectively, p < 0.0001), yielding a similar survival benefit across all four groups. Over a median follow-up of 51 ± 29 months, there were 249 deaths. In highly adjusted models, the FR_low/MG_low group had a higher all-cause mortality (HR = 1.7, 95% CI: 1.1–2.6, p = 0.02) than patients with FR_normal/MG_high. FR had a stronger association with AVA than SVi (r = 0.51 vs. 0.41, respectively, p = 0.0002), and a similar predictive value for death (AUC = 0.57 and 0.58, respectively, p = 0.88). Conclusions: The FR_low/MG_low subset of AS is associated with the worst prognosis, and FR is not superior to SVi in the hemodynamic classification of severe AS.

EVALUATION OF DIASTOLIC FUNCTION BY CARDIAC MAGNETIC RESONANCE IMAGING USING A NOVEL FEATURE TRACKING TECHNIQUE AND COMPARISON WITH ECHOCARDIOGRAPHY IN HEALTHY SUBJECTS

Left ventricular diastolic function is not routinely evaluated by cardiac magnetic resonance imaging (MRI). Feature Tracking (FT-MRI) is a novel tissue tracking method, which can be easily used to derive myocardial velocity. We sought to determine the feasibility of evaluating diastolic function by

THE RELATION BETWEEN LEFT VENTRICULAR WALLS SYSTOLIC DISPLACEMENT BY SPECKLE TRACKING ECHOCARDIOGRAPHY AND INDICES OF LEFT VENTRICULAR SYSTOLIC FUNCTION MEASURED BY 2-D ECHOCARDIOGRAPHY AND CARDIAC MAGNETIC RESONANCE IMAGING IN PATIENTS WITH SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION

Background: Speckle tracking echocardiography (STE) is emerging as a clinical tool for evaluation of left ventricular (LV) regional and global systolic function. We sought to determine the association between the longitudinal, radial and transverse deformation (D) of the LV walls with cardiac MRI and 2-D echo indices of LV performance in healthy and in subjects severe aortic stenosis (AS) and abnormal LV geometry.

PRELIMINARY MECHANISTIC OBSERVATIONS OF DECREASE MITRAL REGURGITATION SEVERITY AFTER AORTIC VALVE REPLACEMENT IN PATIENTS WITH SEVERE ISOLATED AORTIC STENOSIS AND FUNCTIONAL MITRAL REGURGITATION

Methods: Of 330 pts diagnosed in the last 3 years by transthoracic echocardiography (TTE) with severe AS and MR, 21 (mean age = 78 ± 8 yrs, 6 females) had ≥ 2+ functional MR, underwent only AVR and had a post AVR TTE. The echo studies were reanalyzed off line and the accepted criteria for color-Doppler MR jet area were used. Post AVR ≥ 50% decrease in jet area was found in 9 pts. MR severity change was evaluated both as a continuous and categorical variable and adjusted linear regression analysis was performed. Results: The post AVR anatomic and hemodynamic differences are illustrated in the table. Post AVR, mean MR jet area decreased by 48 ± 30%. The only predictor for change in MR severity was the length of the tenting base of mitral leaflets in systole, r = 0.55 ( p =0.01), such that for every mm increase in this variable, the pre-post AVR difference of MR severity decreases by 0.29 cm2.