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ECHOCARDIOGRAPHIC AND HISTOLOGIC CORRELATIONS IN PATIENTS WITH SEVERE AORTIC STENOSIS: INFLUENCE OF OVERWEIGHT AND OBESITY.
Nydia Avila-Vanzzini1*, Juan F. Fritche Salazar1, Nelva M. Vazquez-Castro1, Pedro Rivera-Lara1, Oscar Perez-Mendez1, Humberto Martinez-Herrera1, Mario Gomez-Sanchez1, Alberto Aranda-Frauto1, Hector Herrera-Bello2, Maria Luna-Luna1, Jose A. Arias-Godinez1
1National Institute of Cardiology Mexico Echocardiography
2Medica Sur Clinical Foundation
Corresponding Author: Nydia Avila-Vanzzini ,Tel: 55732911, Email: vazzny74@yahoo.com
ABSTRACT
Background:
Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitant overweight or obesity (OW/O).
Methods:
We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating the percentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) and its relationship to global longitudinal strain (GLS) in patients with OW/O.
Results:
44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with LVEF ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy was obtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater BMI (p< 0.0001) and worse GLS (p<0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect important PIEF (AUC: 0.928, 95% CI: 0.798-1.00). On multivariate analysis, OW/O and PIELV were independently associated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount of PIELV and PIEF were found.
Conclusion:
Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presence of higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.
Keywords: Severe aortic stenosis, Overweight and Obesity, intraendomyocardial fibrosis, global longitudinal
Volume 25, No 3
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