Abstract 11619: Basal Septal Hypertrophy in Severe Aortic Stenosis is Associated With Worse Left Ventricular Diastolic Function but Has Not Impact on the Postoperative Transvalvular Pressure Gradients
Background: Basal septal hypertrophy (BSH) is found in 1.5 %-18% of the general population associated with hypertension. Its significance in severe aortic stenosis (AS) is uncertain. Hypothesis: In AS, BSH may adversely affects LV diastolic function and increases transvalvular gradients after valve replacement (AVR).
Methods: Between 2011-2014, 6012 pts with AS of some degree underwent echocardiography. Severe AS was present in 255 with a septal buldge and normal EF, of whom 30 had BSH (AS+/BSH+). 106 were AS+/BSH-. Controls included 119 AS-/BSH+ pts. 38 with AS+/BSH+ with any EF underwent AVR. BSH was defined as BS diastolic diameter ≥ 15 mm and BS >2 mm thicker than mid septum in PSLAX view in multiple images. Inter and intraobserver reliability were calculated (ICC, n = 20). One-way ANCOVA, Fisher’s exact test and multivariate logistic regression controlled for age, sex and BSA were used as appropriate.
Results: ICC = 0.99 for BS and 0.80 for mid septum. AS+/BSH+ pts were older than AS+/BSH-, more were females and their diastolic function was worse despite similar transvalvular gradients, AVAi, LV mass index (table), and similar medical histories. After controlling for prosthetic valve type and size and stroke volumes, BSH did not affect post AVR transvalvular gradients. In adjusted logistic regression models, BSH was associated with E/A (OR = 2.6, CL s:1.32 and 5.29, p =0.006, AUC = 0.85) and showed a trend toward association with LA area index ( OR = 1.14, CLs,1.14 and 0.99, p = 0.06, AUC = 0.77). Conclusions: 1. Using rigorous criteria,< 4% of pts with severe AS have BSH. 2. AS+/BSH+ have Doppler evidence of higher LV filling pressures despite similar stenosis severity and LV mass than AS +/BSH- pts, so that BSH may be a marker of worse diastolic function. 3. BSH does not affect post AVR transvalvular pressure gradients. 4. Larger prospective studies are warranted to validate these findings and compare outcomes of AS pts with and without BSH.
Author Disclosures: D. Alexandru: None. F. Petillo: None. S. Pollack: None. N. Reichek: None. E. Barasch: None.
- © 2015 by American Heart Association, Inc.