Prevalence and prognostic significance of left ventricular myocardial late gadolinium enhancement in severe aortic stenosis

Rajesh, Gopalan Nair; Thottian, Julian Johny; Subramaniam, Gomathy; Vinayakumar, Desabandhu; Sajeev, C.G.; Krishnan, M.N.

doi:10.1016/j.ihj.2017.05.027

Cited by 19 publications

(13 citation statements)

References 19 publications

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“…Late gadolinium enhancement (LGE) is a well-established imaging method to detect myocardial fibrosis in AS [9]. Several studies analyzed that replacement fibrosis detected by LGE is a strong predictor of poor outcome [22,23]. However, the data about the myocardial fibrosis impact on PH development is lacking.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Morphology and Function as a Determinant of Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Cardiovascular Magnetic Resonance Imaging Study

et al. 2019

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Background and Objectives: The influence of cardiac magnetic resonance (CMR) derived left ventricular (LV) parameters on the prognosis of patients with aortic stenosis (AS) was analyzed in several studies. However, the data on the relations between the LV parameters and the development of pulmonary hypertension (PH) in severe AS is lacking. Our objectives were to evaluate the CMR-derived changes of the LV size, morphology, and function in patients with isolated severe AS and PH, and to investigate the prognostic impact of these parameters on elevated systolic pulmonary artery pressure (sPAP). Materials and Methods: Thirty patients with isolated severe AS (aortic valve area ≤1 cm2) underwent a 2D-echocardiography (2D echo) and CMR before aortic valve replacement. Indices of the LV mass and volumes and ejection fraction were analyzed by CMR. The LV global longitudinal (LV LGS) and circumferential strain (LV CS) were calculated using CMR feature tracking (CMR-FT) software (Medis Suite QStrain 2.0, Medis Medical Imaging Systems B.V., Leiden, The Netherlands). The LV fibrosis expansion was assessed using a late gadolinium enhancement sequence. PH was defined as having an estimated sPAP of ≥45 mm Hg. The statistical analysis as performed using SPSS version 23.0 (SPSS, Chicago, IL, USA) Results: 30 patients with severe AS were included in the study, 23% with severe isolated AS had PH (mean sPAP 55 ± 6.6 mm Hg). More severe LV anatomical and functional abnormalities were observed in patients with PH when compared with patients without PH—a higher LV end-diastolic volume index (EDVi) (140 [120.0–160.0] vs. 90.0 mL/m² [82.5–103.0], p = 0.04), larger LV fibrosis area (7.8 [5.6–8.0] vs. 1.3% [1.2–1.5], p = 0.005), as well as lower LV global longitudinal strain (GLS; −14.0 [−14.9–(−8.9)] vs. −21.1% [−23.4–(−17.8)], p = 0.004). By receiver–operating characteristic (ROC) curve analysis, LV EDVi > 107.7 mL/m² (Area Under the Curve (AUC) 95.7%), LV GLS < −15.5% (AUC 86.3%), and LV fibrosis area >5% (AUC 89.3) were found to be robust predictors of PH in severe AS patients. Conclusions: In patients with severe aortic stenosis, a larger end-diastolic LV volume, impaired LV global longitudinal strain, and larger LV fibrosis extent can predict the development of pulmonary hypertension.

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Morphology and Function as a Determinant of Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Cardiovascular Magnetic Resonance Imaging Study

et al. 2019

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“…(45)2014154Severe AS undergoing AVR1.5-TLGE—LGE present in 29%.LGE was an independent predictor of all-cause mortality (HR: 2.8; 95% CI: 1.1 to 6.9; p = 0.025).Rajesh et al. (81)2017109Severe AS1.5-TLGE—LGE present in 43%.Midwall LGE present in 31%.LGE predicted heart failure/hospitalization and a fall in LVEF but did not predict mortality.Musa et al. (46)2018674Severe AS undergoing AVR1.5-T, 3-TLGE—LGE present in 51%.Noninfarct LGE present in 33%.Scar associated with all-cause (26.4% vs 12.9%; p < 0.001) and cardiovascular (15.0% vs 4.8%; p < 0.001) mortality in a dose-dependent fashion (for every 1% increase in scar, HR: 1.11; 95% CI: 1.05–1.17; p < 0.001 for all-cause and HR: 1.08; 95% CI: 1.01–1.17; p < 0.001 for cardiovascular mortality).Infarct and noninfarct scar were both associated with adverse outcomes.de Meester et al.…”

Section: Imaging Modalities For the Assessment Of Myocardial Fibrosismentioning

confidence: 99%

Imaging and Impact of Myocardial Fibrosis in Aortic Stenosis

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Cavalcante

Everett

et al. 2019

JACC: Cardiovascular Imaging

190

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Aortic stenosis is characterized both by progressive valve narrowing and the left ventricular remodeling response that ensues. The only effective treatment is aortic valve replacement, which is usually recommended in patients with severe stenosis and evidence of left ventricular decompensation. At present, left ventricular decompensation is most frequently identified by the development of typical symptoms or a marked reduction in left ventricular ejection fraction <50%. However, there is growing interest in using the assessment of myocardial fibrosis as an earlier and more objective marker of left ventricular decompensation, particularly in asymptomatic patients, where guidelines currently rely on nonrandomized data and expert consensus. Myocardial fibrosis has major functional consequences, is the key pathological process driving left ventricular decompensation, and can be divided into 2 categories. Replacement fibrosis is irreversible and identified using late gadolinium enhancement on cardiac magnetic resonance, while diffuse fibrosis occurs earlier, is potentially reversible, and can be quantified with cardiac magnetic resonance T1 mapping techniques. There is a substantial body of observational data in this field, but there is now a need for randomized clinical trials of myocardial imaging in aortic stenosis to optimize patient management. This review will discuss the role that myocardial fibrosis plays in aortic stenosis, how it can be imaged, and how these approaches might be used to track myocardial health and improve the timing of aortic valve replacement.

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“…9 Patchy appearance of fibrosis was often used to describe myocardial fibrosis found in hypertrophic cardiomyopathy (HCM) and aortic stenosis (AS). 18,19 Replacement fibrosis in both cases happened because of myocyte apoptosis due to progression of the disease. On the other hand, nonischemic cause of myocardial fibrosis in RHD is inflammatory process.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

et al. 2019

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Myocardial fibrosis in rheumatic mitral stenosis (MS) is caused by chronic inflammatory process. Its occurrence may lead to hemodynamic problems, especially after cardiac surgery. Myocardial fibrosis predicts worse morbidity after cardiac surgery, notably in coronary heart disease and aortic valve abnormalities. However, this issue has not been explored yet among patients with rheumatic MS.The aim of the study was to investigate prognostic impact of myocardial fibrosis to postoperative morbidity after mitral valve surgery in patients with rheumatic MS.This is a prospectively enrolled observational study of 47 consecutive rheumatic MS patients. All patients had preoperative evaluation with cardiac magnetic resonance imaging (CMR) including late gadolinium enhancement (LGE) protocol for left ventricular myocardial fibrosis assessment prior to mitral valve surgery. All patients were followed during hospitalization period. Postoperative morbidities were defined as stroke, renal failure, and prolonged mechanical ventilation.This study involved 33 women (70.2%) and 14 men (29.8%) with a mean age of 46 ± 10 years. Preoperative myocardial fibrosis was identified in 43 patients (91.5%). Estimated fibrosis volume ranged from 0% to 12.8% (median 2.8%). Postoperative morbidities occurred in 11 patients (23.4%). Significant mean difference of myocardial fibrosis volume was observed between patients with and without morbidity after mitral valve surgery (5.97 ± 4.16% and 3.12 ± 2.62%, p = 0.04). This significant association was allegedly influenced by different postoperative hemodynamic changes between the two groups.More extensive myocardial fibrosis is associated with postoperative morbiditiy after mitral valve surgery in patients with rheumatic MS.

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Prevalence and prognostic significance of left ventricular myocardial late gadolinium enhancement in severe aortic stenosis

Cited by 19 publications

References 19 publications

Left Ventricular Morphology and Function as a Determinant of Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Cardiovascular Magnetic Resonance Imaging Study

Left Ventricular Morphology and Function as a Determinant of Pulmonary Hypertension in Patients with Severe Aortic Stenosis: Cardiovascular Magnetic Resonance Imaging Study

Imaging and Impact of Myocardial Fibrosis in Aortic Stenosis

Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

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