R. Capoulade

IMPACT OF AORTIC VALVE CALCIFICATION MEASURED BY MULTIDETECTOR CT ON THE OUTCOME OF PATIENTS WITH AORTIC STENOSIS

Aortic valve calcification (AVC) load measures the lesion severity of aortic stenosis (AS) and discriminates well severe vs. moderate AS. However, the prognostic value of this measure in patients with AS remains largely unknown. Thus, the aim of this study was to evaluate the impact of AVC measured

Prevalence of left ventricle non-compaction criteria in adult patients with bicuspid aortic valve versus healthy control subjects

Objective The aim of this study was to compare the prevalence of left ventricle non-compaction (LVNC) criteria (or hypertrabeculation) in a cohort of patients with bicuspid aortic valve (BAV) and healthy control subjects (CTL) without cardiovascular disease using cardiovascular MR (CMR). Methods 79 patients with BAV and 85 CTL with tricuspid aortic valve and free of known cardiovascular disease underwent CMR to evaluate the presence of LVNC criteria. The left ventricle was assessed at end-systole and end-diastole, in the short-axis, two-chamber and four-chamber views and divided into the 16 standardised myocardial segments. LVNC was assessed using the non-compacted/compacted (NC/C) myocardium ratio and was considered to be present if at least one of the myocardial segments had a NC/C ratio superior to the cut-off values defined in previous studies: Jenni et al (>2.0 end-systole); Petersen et al (>2.3 end-diastole); or Fazio et al (>2.5 end-diastole). Results 15 CTL (17.6%) vs 8 BAV (10.1%) fulfilled Jenni et al’s criterion; 69 CTL (81.2%) vs 49 BAV (62.0%) fulfilled Petersen et al’s criterion; and 66 CTL (77.6%) vs 43 BAV (54.4%) fulfilled Fazio et al’s criterion. Petersen et al and Fazio et al’s LVNC criteria were met more often by CTL (p=0.006 and p=0.002, respectively) than patients with BAV, whereas this difference was not statistically significant according to Jenni et al’s criterion (p=0.17). In multivariable analyses, after adjusting for age, sex, the presence of significant valve dysfunction (>mild stenosis or >mild regurgitation), indexed LV mass, indexed LV end-diastolic volume and LV ejection fraction, BAV was not associated with any of the three LVNC criteria. Conclusion Patients with BAV do not harbour more LVNC than the general population and there is no evidence that they are at higher risk for the development of LVNC cardiomyopathy.

USEFULNESS OF AORTIC VALVE CALCIFICATION MEASURED BY COMPUTED TOMOGRAPHY TO PREDICT HEMODYNAMIC PROGRESSION OF AORTIC STENOSIS

Prediction of Aortic Stenosis (AS) progression is crucial for follow-up and surgical timing. Aortic valve calcification (AVC) measured by Multi Detector Computed Tomography (MDCT) is a fundamental measure of AS lesion severity but it is uncertain whether it predicts faster AS progression. 227 AS

Resting level of plasma brain natriuretic peptide and response to exercise as predictors of outcomes in asymptomatic patients with aortic stenosis

Purpose: Exercise stress echocardiography is useful in the management and risk stratification of patients with asymptomatic aortic stenosis (AS). Resting brain natriuretic peptides (BNP) level is associated with increased risk of adverse events in AS patients. The incremental prognostic value of BNP response during exercise is unknown. The objectives of this study were to assess the correlates of the plasma level of BNP during exercise as well as its usefulness to predict outcomes in asymptomatic patients with AS. Methods: Resting and exercise Doppler-echocardiographic data and BNP levels were prospectively collected in 211 asymptomatic AS patients in 2 centers. Results: Plasma BNP level increased significantly from rest to exercise (65±86 to 91±111 pg/mL, p 43 pg/mL; median value). Conclusion: This study reports that, in asymptomatic patients with AS, peak-exercise BNP level provides important incremental prognostic value beyond what is achieved by demographic and echocardiographic data, as well as resting BNP level. These findings lend support to the measurement of BNP during exercise to enhance risk stratification in asymptomatic AS.

583 Prognostic Value of BNP Level During Exercise in Asymptomatic Patients With Aortic Stenosis

patients with and without events are shown in the Table. Multivariate analysis showed that peak AS velocity (HR 1.076, p 0.0001) and log BNP (HR 1.501, p 0.0082) were independent predictors of outcome, whereas age, aortic valve calcification, and LDL cholesterol were not. CONCLUSION: In mild to moderate AS, AS severity and BNP are predictors of outcome. Thus, more vigilant followup should be given to patients with moderate AS and/or high BNP levels. Measurement of BNP appears to complement echocardiographic assessment in the management of AS patients. Further studies should be conducted to evaluate the role of BNP.