P1367 Prevalence of left ventricular hypertrophy, diastolic dysfunction and pulmonary hypertension in patients with severe aortic valve stenosis

Abstract Background The prognostic and therapeutic consequences of aortic valve stenosis (AS) are incompletely described by the effective orifice area (EOA) and transvalvular flow velocities (AV-Vmax) in echocardiography. The aim of the study was to evaluate parameters of left ventricular hypertrophy (LVH), diastolic dysfunction and pulmonary artery hypertension (PAH) in severe AS. Methods Patients (n = 320) with severe AS (mean age 78 ± 9.5 years) defined by EOA < 1cm2 and/or a AV-Vmax > 4m/s were included. Left ventricular (LV) volumes and ejection fraction (EF), relative wall thickness (RWT), LV mass index (LVmassi), several parameters of diastolic function, e.g. E/A-ratio, e/e", indexed left atrial (LA) volumes (LAVI min. and max.) and systolic pulmonary artery pressure were assessed. Patients were grouped in four subgroups according to their mean pressure gradient (mPGAV) and indexed stroke volume (Low-Flow/Low-Gradient (LFLG), Normal-Flow/Low-Gradient (NFLG), Low-Flow/High-Gradient (LFHG) and Normal-Flow/High-Gradient (NFHG)). Results LVH was documented in 83%, diastolic dysfunction in 75% and PAH in 79% of all patients, whereas > 50% exhibited pathological values for all three and 82% for at least two of these cardiac alterations. Further, in no patient normal ranges of all three cardiac alterations were observed. EOA (0.74 ± 0.18 vs 0.78 ± 0.17, p = 0.047) was lower and mPGAV (34.0 ± 16.6 vs 29.3 ± 14.1, p = 0.009) was higher in patients presenting all three cardiac alterations vs. patients presenting less than three cardiac alterations. Prevalences of diastolic dysfunction and LVH did not differ among AS subgroups (Fig.1/Tab. 1, p > 0.05). In contrast, higher prevalence of PAH was observed in HG-AS (89%) compared to LG-AS (76%) (p = 0.02). Conclusion Severe AS is highly associated with LVH, diastolic dysfunction and PAH. This analysis sets the stage to determine the prognostic importance of the analyzed cardiac alterations in patients with severe AS. Tab.1-Prevalence of cardiac alterations Parameters LFLG-AS (n = 135) NFLG-AS (n = 97) LFHG-AS (n = 21) NFHG-AS (n = 67) Relative wall thickness > 0.42 121 (89%) 90 (92%) 19 (90%) 67 (100%) LVmass index > 115 g/m2 (men), > 95 g/m2 (women) 120 (88%) 84 (86%) 17 (81%) 62 (93%) e/e" > 14 94 (70%) 56 (59%) 15 (71%) 41 (61%) Tricuspid regurgitation > 2.8 m/s 95 (70%) 71 (75%) 16 (76%) 47 (70%) Increased LAP and diastolic dysfunction grade 2 or 3 103 (76%) 69 (73%) 17 (81%) 50 (75%) Abstract P1367 Figure. Fig.1-Prevalence of cardiac alterations