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Prevalence and Prognostic Impact of Apical Sparing Contractility Pattern in Patients with Aortic Stenosis Referred for Transcatheter Aortic Valve Implantation

2021Journal article Open access
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dc.contributor.authorFerreira, V
dc.contributor.authorAguiar Rosa, S
dc.contributor.authorPereira-da-Silva, T
dc.contributor.authorRodrigues, I
dc.contributor.authorGonçalves, A
dc.contributor.authorMendonça, T
dc.contributor.authorCastelo, A
dc.contributor.authorBranco, LM
dc.contributor.authorGalrinho, A
dc.contributor.authorFiarresga, A
dc.contributor.authorRamos, R
dc.contributor.authorPatrício, L
dc.contributor.authorCacela, D
dc.contributor.authorCruz Ferreira, R
dc.date.accessioned2022-03-03T13:05:30Z
dc.date.available2022-03-03T13:05:30Z
dc.date.issued2021
dc.description.abstractIntroduction: Prolonged afterload increase in aortic stenosis (AS) may alter left ventricular (LV) contractility, irrespective of LV ejection fraction (LVEF). The prevalence and morbimortality associated with the apical sparing strain pattern (ASP), a typical finding of cardiac amyloidosis (CA), are not fully understood in patients with AS. We assessed the prevalence of the ASP in patients with severe AS and its clinical impact after transcatheter aortic valve implantation (TAVI). Methods: Eighty-nine consecutive patients with severe AS and LV hypertrophy referred for TAVI were included. Baseline clinical and echocardiographic data were assessed, including the ASP in bull's eye plots (ASPB), relative apical longitudinal strain (RALS) and EF to global longitudinal strain (EF/GLS) ratio. We analysed all-cause mortality; a composite of all-cause mortality, stroke, and heart failure hospitalizations; and the rate of pacemaker implantation, after TAVI. Results: Mean age was 82 ± 6 years and mean LVEF was 57 ± 10%. ASPB and RALS >1 were present in 43.8% and 24.7% of patients, respectively. Over a median follow-up of 13 months (IQR 6-32), ASPB was associated with higher rates of all-cause mortality (log-rank P=0.001) and was an independent predictor of all-cause mortality in multivariate analysis. Combination of the ASPB and GLS or EF/GLS ratio improved the risk stratification. Patients with RALS >1 were more likely to have new BBB and an indication for pacemaker implantation (P=0.048). Conclusion: The ASP, as assessed by the ASPB and RALS, was frequent in patients with AS regardless of the diagnosis of CA. The ASPB may refine risk stratification in patients referred for TAVI.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationAm J Cardiovasc Dis. 2021 Jun 15;11(3):283-294.pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3978
dc.language.isoengpt_PT
dc.subjectHSM CARpt_PT
dc.subjectApical Sparingpt_PT
dc.subjectAortic Stenosispt_PT
dc.subjectCardiac Amyloidosispt_PT
dc.subjectStrain Echocardiographypt_PT
dc.subjectTranscatheter Aortic Valve Implantationpt_PT
dc.titlePrevalence and Prognostic Impact of Apical Sparing Contractility Pattern in Patients with Aortic Stenosis Referred for Transcatheter Aortic Valve Implantationpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage294pt_PT
oaire.citation.startPage283pt_PT
oaire.citation.titleAmerican Journal of Cardiovascular Diseasept_PT
oaire.citation.volume11pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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