Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry.

BACKGROUND: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. METHODS: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. RESULTS: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). CONCLUSION: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis.

Ischaemia-driven optimal therapeutic approach in asymptomatic patients with high cardiovascular risk: the value of clinical, laboratory and myocardial spect imaging findings.

BACKGROUND: We wanted to evaluate the presense of myocardial ischaemia in asymptomatic patients with high cardiovascular risk, the influencing clinical and laboratory factors and the impact of ischaemia on final management decision. MATERIAL AND METHODS: We evaluated 60 asymptomatic patients with high CV risk, who underwent SPECT myocardial perfusion imaging (MPI) for detection of suspected CAD. We used the 17 segment model for quantitative and semiquantitative scan perfusion and function analysis using perfusion scores. All patients had full blood laboratory analyses including lipid values, presence of albuminuria, rest and stress ECG. Logistic regression analysis was used to assess the impact of clinical and laboratory parameters on myocardial ischaemia prevalence. RESULTS: Stress-inducible ischaemia was found in 19 pts (33%), fixed defects were found in 13% and mixed defects in 9% of cases. The average ischaemia amount was 10%. Mild ischaemia was found in 12 patients (64%)--summed stress score (SDS)<4, moderate ischaemia in 5 patients (26%)--SDS 5-7 and severely abnormal scans in 2 patients (10%)--SDS>7. Severe ischaemia was only related to the duration of diabetes. Six pts with severe ischaemia had ST depression>2 mm on stress study, and a higher wall motion index and LVEF fall>5% during stress study (p<0.01). Stepwise logistic regression analysis for prediction of stress-induced ischaemia showed OR 2.4 (95% CI 1.7-3.6) for stress-induced ECG changes and OR 3.9 for presence of DM over 10 y (95% CI 2.3-6.6). Seven patients with ischaemia>10%, were referred for coronary angiography. CONCLUSIONS: MPI is a valuable method for preclinical assessment of myocardial ischaemia in patients with high CV risk, which can improve prognosis and guide treatment decision.