P655 Prognostic value of the new classification of ventricular remodeling in severe aortic stenosis

Abstract

Introduction remodeling is defined as the changes produced in the geometry of the left ventricle after damage or overload of the myocardium. The most common classification only considers left ventricle relative wall thickness and mass index, but a new classification includes also end-diastolic volume index. Purpose to determine if the new patterns of ventricular remodeling had clinical relevance according to symptoms or cardiovacular outcomes. Methods patients with severe aortic stenosis (valve area <1cm2) between 2015 and 2018 were included, excluding other concomitant at least moderate valvular diseases. The patients were classified according to the indexed ventricular mass, relative parietal thickness and left ventricular volume. Cardiovascular mortality was analyzed as the primary endpoint. Results we recruited 234 patients with severe aortic stenosis (55% women, age 77 ± 9 years) with a BMI of 29 ± 5, of which 82% were hypertensive, 47% diabetic, 47% dyslipidemic and 19% smokers. 81% were symptomatic. The average time of follow-up was 280 ± 231 days. 1% had eccentric hypertrophy, 7% mixed hypertrophy, 3% dilated hypertrophy, 73% concentric hypertrophy, 15% concentric remodeling; no patient presented normal ventricle or physiological hypertrophy. Dyspnea was the predominant symptom 100% in eccentric, mixed and dilated hypertrophy; 72% in concentric hypertrophy and 85% in concentric remodeling (p = 0.05). Most patients with mixed hypertrophy had NYHA functional class> II: 0% vs 62% vs 37% vs 27% vs 37% (p = 0.008). The group with the highest cardiovascular mortality was mixed hypertrophy (0% vs 43% vs 0% vs 14% vs 11%, p = 0.04), also shown in the survival analysis (Log Rank = 0.009) (Graph 1). Conclusions in patients with severe aortic stenosis, the pattern of mixed hypertrophy was an adverse prognostic marker in our study, although prognostic role of these new remodeling patterns needs to be investigated in future prospective studies. Abstract P655 Figure. Graph 1.: Kaplan-Meier survival function