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Introduction Chronic obstructive pulmonary disease (COPD) and aortic stenosis (AS) are the most common diseases in aging population that their prevalence and percental change in mortality increase over the years. In severe AS, aortic valve replacement (AVR) is the only treatment that has demonstrated to improve survival, however the presence of comorbidities increases the operative risk and influences negatively on the outcomes after AVR. Therefore, the definition of COPD varies across the studies and is not always based on the use of pulmonary functional tests. Accordingly, the aim of the present study is to evaluate the association between pulmonary functional parameters and all-cause mortality after AVR in a large cohort of patients with severe AS. Methods Total of 400 patients (78.0 year-old, 56.7% men) with severe AS and documented preoperative pulmonary functional test (PFT) were retrospectively analyzed. Demographic and clinical characteristics were collected from electronic medical records while echocardiography was performed and measured according to the recommendations. PFTs were performed prior to AVR and categories defined in the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database: normal pulmonary function was defined by an FEV1 >75% of predicted; mild COPD if FEV1 was 60–75% of predicted; moderate COPD if FEV1 was 50–59% of predicted and severe COPD when FEV1 <50% of predicted. Results Mild, moderate and severe COPD were documented in 75 (19%), 31 (8%) and 22 (5%) while the remaining 68% had normal PFTs. Patients with moderate and severe COPD had significantly larger LV mass and LV end-systolic volume whereas LV ejection fraction was significantly lower. The FVC, FEV1, Tiffeneau index, VC, PEF, and IC were the worst among patients with moderate and severe COPD (per definition) (p<0.0001). Over a median follow-up of 32 months, 92 (23%) patients died. The survival rates were significantly lower in patients with moderate and severe COPD (Log rank p=0.003, Figure 1). In multivariable Cox regression analysis, some clinical factors and COPD were independently associated with all-cause mortality (table 1). Remarkably, any grade of COPD was associated with 2-fold increased risk of all cause-mortality (HR 1.933; 95% CI 1.166–3.204; p=0.011 for mild COPD and HR 2.028; 95% CI 1.154–3.564; p=0.014 for moderate/ severe COPD, separately). Conclusion Patients with moderate and severe COPD had higher LV hypertrophy and reduced LV ejection fraction while PFT parameters were the worst among these patients. The survival rates were significantly lower in patients with moderate and severe COPD compared with patients without COPD. In addition to other clinical factors, any grade of COPD was associated with 2-fold increased risk of all cause-mortality. Funding Acknowledgement Type of funding sources: None.

Background Chronic obstructive pulmonary disease (COPD) is one of the most common comorbidities in patients with aortic stenosis (AS) and has been associated with a poor prognosis after both transcatheter and surgical aortic valve replacement (AVR). Since COPD is associated with an increase in right ventricular (RV) afterload, some studies already suggested that COPD causes RV dysfunction (RVD) and dilatation. On the other hand, RVD and remodeling can also occur due to chronic pressure overload secondary to the AS itself. However, there is no data that studied RVD and remodeling in AVR recipients in terms of COPD severity. Purpose We aimed to evaluate the impact of COPD on RVD and remodeling in patients with severe AS undergoing AVR before AVR and at 1-year follow-up, as well as the association between COPD severity and all-cause mortality. Methods Patients with severe AS who received either transcatheter or surgical AVR were included. Patients' demographic data, medical history and documented spirometry data were carefully collected, while two-dimensional and speckle tracking echocardiography measurements were performed according to recommended guidelines to evaluate RV systolic function and RV size. RVD was defined as tricuspid annular plane systolic excursion (TAPSE) ≤17mm. RV dilatation was defined by RV mid cavity >35 mm, RV basal diameter >42mm, and RV longitudinal diameter >83mm. RV wall thickness above 5mm was considered as RV hypertrophy. Diagnosis of COPD was determined by the Society of Thoracic Surgeons' definition based on forced expiratory volume in first second (FEV 1<75%, cut-off for COPD). The primary outcome was all-cause death at 1-year. Results A total of 293 patients (78.0 years, 58.4% male) were included. RVD was detected in 54 (18.4%) patients, while 55 (18.8%) patients had mild COPD and 43 (14.7%) patients had moderate or severe COPD. At 1-year follow-up, the prevalence of RVD significantly increased (18.4% versus 23.6%, p=0.004). Compared to baseline, RV free wall strain of lateral basal segment (p=0.046), TAPSE (p<0.0001) and tricuspid regurgitation gradient (p=0.018) impaired whereas RV wall thickness (p=0.014), RV diameter index of lateral basal segment (p<0.0001), and RV diameter index of lateral mid segment (p<0.0001) increased, respectively. At 1-year follow-up, 33 patients died (Figure 1). On multivariate cox regression analysis, RVD (hazard ratio (HR) 2.781, 95% confidence interval (CI) 1.172–6.598; p=0.020) as well as mild (HR 4.695, 95% CI 1.787–12.336; p=0.002) and moderate-severe COPD (HR 4.725, 95% CI 1.717–13.006; p=0.003) were significantly associated with the endpoint (Table 1). Conclusions The prevalence of RVD significantly increased and it deteriorated at 1-year after AVR. RV remodeling observed more at lateral basal and mid segments of RV as well as wall thickness. RV dysfunction and COPD were the strongest predictors of mortality in this population. Funding Acknowledgement Type of funding sources: None.

Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): EACVI Training Grant App000073275. Background Aortic stenosis (AS) is the most common valvular heart disease in developed countries and when indicated can be treated with transcatheter aortic valve implantation (TAVI). Recently, a cardiac damage staging (including the left ventricle, the left atrium and mitral regurgitation, the pulmonary pressures and tricuspid regurgitation, and finally the right ventricle, Figure 1) has been proposed in severe AS to optimize risk stratification, but there is still paucity of data about potential sex-differences for this classification. Purpose to identify differences between men and women in cardiac damage before and after TAVI, and evaluate the potential prognostic value. Methods A total of 734 patients with severe AS undergoing TAVI were included. Demographic and clinical data were collected before TAVI. Echocardiography was performed before and 6 months after TAVI, and patients were hierarchically classified in a given cardiac damage stage (worst stage) if at least one of the proposed criteria was met (Figure 1). The primary endpoint was all-cause mortality at long-term follow-up (3.2 years ± 1.3 starting from the 6 months follow-up echocardiography). Results At baseline women (n=334, 45%) were older (81.3 ± 6.7 years vs 78.5 ± 7.7 years, p<0.0001), had fewer cardiovascular risk factors but higher heart rate and blood pressure compared to men. By echocardiography before TAVI, cardiac damage distribution was overall comparable (p = 0.056) between men and women although women showed higher percentage of patients in stage 3 (p<0.05, Figure 2). After TAVI, an improvement in cardiac damage staging was observed with less patients in stage 3 and 4, but a significant difference (p<0.0001) was observed between men and women, having women still more patients in stage 3 (p<0.05) and men more patients in stage 4 (p<0.05) (Figure 2). During long-term follow-up, 206 events occurred (n=79 in women and n=127 in men) and Kaplan-Meier curve analysis illustrated that women had better survival than men (Log-rank p = 0.018; Chi-square 5.642) after TAVI. However, in the multivariate cox regression analysis, at each increment of cardiac damage stage women had higher increased risk for all-cause mortality (HR 1.480, CI 1.143–1.914, p = 0.003) as compared to men (HR 1.206, CI 1.002–1.451, p = 0.003) after adjusting for significant clinical covariates. Conclusions Women and men with severe AS present different cardiac damage staging namely after treatment with TAVI. Although women show better survival after TAVI, cardiac damage staging is of important prognostic value in both sex.

Funding Acknowledgements Type of funding sources: None. Background The evaluation of left ventricular (LV) filling pressure using left atrial (LA) reservoir strain on echocardiography has demonstrated high feasibility and good accuracy. Other LA strain components, such as conduit and booster strain, may show additional diagnostic value for the detection of elevated LV filling pressure. The current automated LA strain analysis has the potential to predict elevated LV end-diastolic pressure (LVEDP) using all LA strain components. Aims The aim of this study is to assess the diagnostic accuracy of automated LA strain for the detection of elevated LVEDP as measured by invasive catherization in comparison to conventional echocardiographic parameters. Methods We included the patients with aortic stenosis (AS) who underwent echocardiography within 48 hours prior to transcatheter aortic valve implantation and had LVEDP measured by catherization during procedure. Patients with atrial fibrillation, previous mitral valve surgery, and mitral stenosis were excluded. LA strain components were measured from apical 4-chamber view using commercial software (AutoStrain LA, Tomtec). (Abstract Picture 1) Elevated LVEDP was defined as a threshold of LVEDP ≥16 mmHg. The cut-off value of conventional echocardiographic parameters for detection of elevated LVEDP were determined according to current guidelines. Results A total of 95 patients (84 ± 7 years, 53% men) were included in this study. Elevated LVEDP was shown in 42 patients. The sensitivity and diagnostic accuracy for the detection of elevated LVEDP on automated LA strain were the best among conventional echocardiographic parameters, including peak reservoir LA strain. (Abstract picture 2) The diagnostic accuracy of automated LA strain was similar between in patients with LV ejection fraction ≥ 50% and those with LV ejection fraction <50% (82% vs 86%). Conclusions Automated LA strain analysis demonstrated superior diagnostic accuracy for the detection of elevated LVEDP in patients with AS. It might thus serve as a non-invasive and accurate alternative method for assessment of elevated LV filling pressure.