81st SIC National Congress 2020 Abstracts VALVULOPATHIES 572 Extent of cardiac damage and mortality in patients undergoing transcatheter aortic valve implantation Marisa Avvedimento 2 , Attilio Leone 2 , Domenico Simone Castiello 2 , Domenico Angellotti 2 , Federica Ilardi 2 , Roberta Esposito 2 , Cristina Iapicca 2 , Raffaele Piccolo 2 , Plinio Lorenzo Cirillo 2 , Anna Franzone 2 , and Giovanni Esposito 2 1 Dipartimento di Emergenze Cardiovascolari, Medicina Clinica e Del  lInvecchiamento, Azienda Ospedaliera Universitaria Federico II, 2 Dipartimento di Scienze Biomediche Avanzate, Azienda Ospedaliera Universitaria Federico II Aims: Degenerative aortic stenosis (AS) is the most common heart valve disease among people 65 years in developed countries, with an increasing prevalence due to population ageing. A recently proposed staging classification of AS is based on the assumption that there is a continuum in the pathophysiology of LV structural and functional changes induced by AS. Such system showed prognostic ability among patients from the PARTNER 2 trial as well as in asymptomatic subjects with moderate to severe AS, thus challenging the current management of the disease. The aim of our study was to assess the prognostic performance of this staging classification in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI) and to investigate the eventual impact of the procedure on the extent of extra-aortic valve cardiac damage. Methods and results: A staging classification was applied to 262 patients from the EffecTAVI Registry. The following criteria for staging classification of cardiac damage were applied at baseline (within 1month before TAVI) and after the procedure (within 30-day): Stage 0, no extra-aortic valve cardiac damage; Stage 1, LV damage as defined by the pres- ence of LV hypertrophy (LV mass index >95 g/m2 for women, >115 g/m2 for men), severe LV diastolic dysfunction (E/e’ >14) or LV systolic dysfunction (LVejection frac- tion, LVEF <50%); Stage 2, left atrial (LA) and/or mitral valve damage as defined by the presence of LA enlargement (LA volume > 34 ml/m 2 ) and/or moderate-severe mitral regurgitation and/or atrial fibrillation; Stage 3, pulmonary vasculature and/or tricuspid valve damage as defined by the presence of systolic pulmonary hyperten- sion (systolic pulmonary arterial pressure, PAPS > 60 mmHg) and/or moderate/severe tricuspid valve regurgitation; Stage 4, right ventricular (RV) damage as defined by the presence of moderate-severe RV systolic dysfunction (tricuspid annular systolic excursion, TAPSE < 17 mm). The primary endpoint of the study was all-cause mortal- ity at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis and re-hospitalization for all causes. At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/ left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-day after TAVI, a lower preva- lence of advanced stages of cardiac damage than baseline, mainly driven by a signifi- cant improvement in left ventricular diastolic parameters and right ventricular func- tion, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p ¼ 0.08). No differences were found in secondary endpoints. Conclusion: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline signifi- cantly affects the risk of mortality at 1-year after the procedure. 178 Concomitant functional mitral regurgitation during the natural history of aortic valve stenosis Martina Setti 1 , Giovanni Benfari 1 , Stefano Nistri 2 , Diego Fanti 1 , Caterina Maffeis 1 , Elvin Tafciu 1 , Michele Pighi 1 , Mariantonietta Cicoira 1 , Andrea Rossi 1 , and Flavio Luciano Ribichini 1 1 Cardiology Unit, University of Verona, 2 Cardiology Service-CMSR Veneto Medica, Altavilla Vicentina (VI) Aims: The importance of functional-mitral-regurgitation (FMR) in patients with aortic- valve-stenosis (AS) is unknown, due to the infrequent quantification and absence of studies. In addition, FMR prognostic relevance has only been studied before aortic valve replacement, and no-data are available during the medical follow-up. Methods and results: Consecutive echocardiograms between 2010-2014 were retro- spectively reviewed. Inclusion criteria were transaortic-velocity >2.5 m/sec and mitral effective-regurgitant-orifice area (ERO) in the presence of mitral regurgita- tion. Organic mitral valve disease was an exclusion-criteria. Primary-endpoint was heart-failure or death under medical-management. Secondary endpoint was heart- failure or death. Eligible patients were 189, age 79 6 8 years, 61% NYHAI/II, indexed- aortic-valve area (AVA) 0.55 6 0.17cm 2 /m 2 . Mitral ERO was 7.6 6 4.2mm2 (>10 mm 2 in 30% of patients). Longitudinal function (by S’-TDI) was associated with mitral ERO independently of ejection fraction and ventricular volumes (p ¼ 0.01). ERO > 10 mm 2 (threshold identified by spline survival-modelling) was associated with severe symp- toms (OR 3.1[1.6-6.0]; p ¼ 0.0006) and higher pulmonary-arterial-pressure (OR 3.0 [1.4-5.9]; p ¼ 0.002). Follow-up was completed for 175 patients. After 4.7[1.4–7.2] years, 87 (50%) patients underwent AVR, 66 (38%) had heart-failure, 64 (37%) died. No procedure on FMR was required. Mitral ERO was independently associated with primary and secondary end- points both as continuous variable (HR 1.15[1.00-1.30]; p ¼ 0.04 and HR 1.23 [1.05- 1.43]; p ¼ 0.01 per 5 mm 2 ERO increase) or as ERO> vs. 10 mm 2 (Figure). Adjustment for S’-TDI or subgroup-analysis did not affect results. The analysis by AVA revealed the incremental prognostic role of mitral ERO over AS severity. Conclusion: AS patients with concomitant FMR >10 mm 2 holds higher risk during medical follow-up. FMR quantitation, even for volumetrically modest regurgitation, provides incremental prognostic information over AS severity. 244 Bicuspid aortic valve disease from infancy to older age: a 25-year experience from an Italian Referral Centre Annachiara Benini 1 , Giovanni Benfari 1 , Mara Pilati 1 , Flavio Luciano Ribichini 1 , 1 , and Maria Antonia Prioli 1 1 AZIENDA OSPEDALIERA UNIVERSITARIA INTEGRATAVERONA Aims: Bicuspid aortic valve (BAV) is the most common congenital heart defect, with con- siderable risk of morbidity and mortality. The purpose of the study was to analyse clinical and echocardiographic presentation of BAV in a large volume tertiary Italian centre and to test their interaction with full-age span, sex and first diagnosis vs. second referral. Methods and results: Consecutive patients of all ages diagnosed with BAV in our centre from January 1988 to December 2012 were retrospectively included. Exclusion criteria were: associated complex congenital cardiac disease, systemic syn- drome and previous cardiac surgery. Eligible patients were 790, divided by age quar- tiles (the mean age of the sub-groups was respectively 3.8 6 3.3 years, 18.1 6 4.7 years, 37.6 6 6.2 years and 59.2 6 8.3 years). Global mean age was 29.6 6 21.6 years with a male predominance of approximately 3:1. 72% of patients had any grade BAV dysfunction. Aortic valve stenosis was more frequent in the first (24%) and fourth (24%) quartile. This corresponds to a double-peak stenosis severity curve 2, being more severe at a very young age and in the elderly. Aortic valve regur- gitation was more prevalent in each quartile than stenosis, with a prevalence of 72% in the second and 77% in the third quartile. This corresponds to a single-peak regurgi- tation severity curve 2, being more severe in the fourth and fifth decades of life. Patients with previously diagnosed BAV had more significant valve dysfunction in comparison to patients with first diagnosis of BAV, either stenosis (15% vs 21%, p ¼ 0.024) or regurgitation (58% vs 68%, p ¼ 0.006). The rate of new diagnosis and the prevalence of valve dysfunction showed minor and not significant fluctuation over time (respectively, p ¼ 0.22, p ¼ 0.38). Conclusion: The main value of the present study is the extensive evaluation of prev- alence and severity of bicuspid aortic valve in a large population of consecutive patients. The dominant bicuspid aortic valve dysfunction in this large Italian com- munity is regurgitation, with higher severity of disease in the fourth and fifth deca- des of life. Indeed, it is mandatory to search for significant regurgitation when a bicuspid aortic valve is diagnosed, especially in the third to fifth decades, with a careful follow-up, since it can be associated with significant medical and surgical morbidity over the life of affected individuals. Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author 2020. For permissions please email: journals.permissions@oup.com European Heart Journal Supplements (2020) 22 (Supplement N), N138–N141 The Heart of the Matter doi:10.1093/eurheartj/suaa209 Downloaded from https://academic.oup.com/eurheartjsupp/article/22/Supplement_N/N138/6040995 by guest on 03 May 2021