Abstract 17723: Low-flow Low-gradient Aortic Stenosis With Low Ejection Fraction: Does Myocardial Fibrosis Predict Recovery of Postoperative Ventricular Function?
Introduction: There is a lack of studies related to predictors of ventricular function improvement after surgical intervention in patients with low-flow low-gradient aortic stenosis with low ejection fraction (LFLGAS).
Hypothesis: Our objective was to evaluate the impact of myocardial fibrosis assessed by Cardiac Magnetic Resonance (CMR) in clinical, laboratory and ventricular function improvement in patients with LFLGAS after conventional surgery.
Methods: This is a prospective study with 12 patients with LFLGAS. All patients underwent dobutamine stress echocardiography (DSE), three-dimensional echocardiography, CMR with late enhancement and T1 mapping technique and laboratory tests before and after surgery. All patients had true severe aortic stenosis confirmation and underwent valve replacement.
Results: The mean age was 68 ± 8 years, 91.6% male, 100% with degenerative etiology. We found high prevalence of comorbidities, highlighting diabetes (50%), arterial hypertension (75%), atrial fibrillation (16.6%) and coronary artery disease (25%). All patients had left ventricle contractile reserve, defined by a 20% increase of LV stroke volume in DSE. CMR delayed enhancement was found in 58.3% and mean extra-cellular volume of fibrosis was 28.12 ± 3.6%. Pre and postoperative data are shown in Table 1. Despite the high percentage of CMR T1 mapping myocardial fibrosis, there was significant improvement in LV function and LV volume reduction measured by three-dimensional echocardiography, suggesting that ventricular hemodynamic improvement seems to be dissociated from myocardial fibrosis.
Conclusion: In this study, in patients with LFLGAS, hemodynamic improvement (recovery of ventricular function) occurs despite of severe myocardial fibrosis.
Author Disclosures: V.E. Rosa: None. R.O. Sampaio: None. A.S. de Santis: None. J.C. Fernandes: None. T.A. Accorsi: None. M.E. Rosa: None. M.L. Vieira: None. T.C. Morais: None. J.H. Bello: None. W. Mathias Jr: None. C.E. Rochitte: None. P.M. Pomerantzeff: None. F. Tarasoutchi: None.
- © 2016 by American Heart Association, Inc.