Coronary microvascular reserve and outcome in aortic stenosis: Pathophysiological significance vs. clinical relevance

Lancellotti, Patrizio; Nchimi, Alain

doi:10.1093/eurheartj/ehw635

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…6 The fact that clinical symptoms occur at the end of the ischemic cascade (whereas perfusion abnormalities can be detected earlier) places great expectation on the physiological evaluation of AS. 7…”

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confidence: 99%

Coronary Microcirculation in Aortic Stenosis

McConkey

Marber

Chiribiri

et al. 2019

Circ: Cardiovascular Interventions

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confidence: 99%

Coronary Microcirculation in Aortic Stenosis

McConkey

Marber

Chiribiri

et al. 2019

Circ: Cardiovascular Interventions

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“…In the recent years, it has been growingly acknowledged that AS encompasses a wide spectrum of pathways in response to the progressive obstruction of the left ventricular (LV) outflow. These include first adaptive responses such as LV concentric hypertrophy that relieves the wall stress in response to LV overload, then maladaptive responses such as myocardial ischemia and fibrosis that eventually lead to myocardial dysfunction and cardiac output failure ( 2 , 3 ). The concurrent progresses in computed tomography (CT), cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) have given rise to imaging biomarkers allowing quantification of the structural remodeling of both the aortic valve and the underlying myocardium ( 4 ).…”

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confidence: 99%

Predicting Disease Progression and Mortality in Aortic Stenosis: A Systematic Review of Imaging Biomarkers and Meta-Analysis

Nchimi

Dibato

Davin

et al. 2018

Front. Cardiovasc. Med.

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Background: Detecting among patients with aortic stenosis (AS) those who are likely to rapidly progress, yet potentially benefiting from prophylactic aortic valve replacement, is needed for improved patient care. The objective of this study was to evaluate the role of imaging biomarkers in predicting the progression to clinical symptoms and death in patients with AS.Methods: We searched the Pubmed and the International Clinical Trials Registry Platform databases for studies including patients with AS, and investigating imaging techniques, published in any language until Jan 1, 2018. Eligible sets of data include effect of imaging biomarkers relative to: (1) Overall mortality, (2) Cardiac mortality, and (3) Overall events (Symptom onset and Major Adverse Cardiovascular Events). Meta-analysis was used to examine associations between the imaging biomarkers and outcomes of AS using Random Effect models.Results: Eight studies and 1,639 patients were included after systematic review. Four studies investigated aortic valve calcification (AVC) whereas the remaining investigated biomarkers provided by cardiac magnetic resonance (CMR). Four articles investigated the presence of midwall fibrosis on late-gadolinium enhancement imaging, three reported its extent (LGE%) and two, the myocardial extracellular volume (ECV). By decreasing strength of association, there were significant associations between cardiac mortality and LGE% [Relative Risk (RR) = 1.05, 95% Confidence Interval (CI) 1.01–1.10]; overall mortality and AVC (RR = 1.19, 95%CI: 1.05–1.36); overall events and ECV (RR = 1.68, 95%CI: 1.17–2.41); cardiac mortality and midwall fibrosis (RR = 2.88, 95%CI: 1.12–7.39).Conclusion: AVC and myocardial fibrosis imaging biomarkers predict the outcomes in AS, and help understanding AS pathophysiology and setting therapeutic targets.

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Myocardial Fibrosis Predicts 10-Year Survival in Patients Undergoing Aortic Valve Replacement

Herrmann

Fries

Salinger

et al. 2018

Circ: Cardiovascular Imaging

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Background Long-term data on evolution and clinical impact of myocardial fibrosis in valvular heart disease are scarce. Methods and Results In this 10 years’ extension of a prospective study in patients undergoing conventional aortic valve replacement because of symptomatic severe aortic valve stenosis, the impact of myocardial replacement fibrosis (MRF) on long-term outcome was assessed. Endomyocardial biopsies were acquired during aortic valve replacement in 58 consecutive patients. MRF was graded using the calculated percentage area of fibrosis and patients categorized as severe (n=21), mild (n=15), and no fibrosis (n=22). Echocardiography including strain imaging, as well as cardiovascular magnetic resonance, to assess late gadolinium enhancement was performed at baseline, 1, and 10 years after aortic valve replacement. Death of any cause occurred in 21 patients (38.9%): 3 (14.3%) in the group without MRF, 6 (42.9%) in the mild MRF group, and 12 (63.2%) in the severe MRF group ( P =0.006), resulting in the lowest cumulative survival for patients with severe MRF (log-rank P =0.003). In the group without MRF, none died of cardiovascular cause. MRF was found to be an independent predictor of survival (hazard ratio, 1.271; 95% CI, 1.032–1.564; P =0.024). Conclusions This 10-year follow-up study underlines the profound impact of replacement fibrosis with regard to cardiac and all-cause mortality in patients undergoing aortic valve replacement for severe aortic valve stenosis. Integrating cardiovascular magnetic resonance and echocardiographic functional imaging beyond ejection fraction quantification could help in clinical decision making to stratify patient prognosis with regard to myocardial longitudinal function and prevalence of replacement fibrosis.

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Coronary microvascular reserve and outcome in aortic stenosis: Pathophysiological significance vs. clinical relevance

Cited by 3 publications

References 17 publications

Coronary Microcirculation in Aortic Stenosis

Coronary Microcirculation in Aortic Stenosis

Predicting Disease Progression and Mortality in Aortic Stenosis: A Systematic Review of Imaging Biomarkers and Meta-Analysis

Myocardial Fibrosis Predicts 10-Year Survival in Patients Undergoing Aortic Valve Replacement

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