Prognostic Significance of Myocardial Fibrosis Quantification by Histopathology and Magnetic Resonance Imaging in Patients With Severe Aortic Valve Disease

Azevedo, Clerio F.; Nigri, Marcelo; Higuchi, Maria de Lourdes; Pomerantzeff, Pablo Maria Alberto; Spina, Guilherme Sobreira; Sampaio, Roney Orismar; Tarasoutchi, Flávio; Grinberg, Max; Rochitte, Carlos Eduardo

doi:10.1016/j.jacc.2009.12.074

Cited by 478 publications

(347 citation statements)

References 34 publications

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“…11-13,31- 33 Azevedo et al have shown significantly worse long-term survival and LV functional improvement after aortic valve surgery for severe AS or AR in patients with ≥30% myocardial fibrosis measured by histopathology. 34 Corroborating those results, the present study demonstrated a significant correlation between DMF and LV mass. 12,31,32, 35 Patients with severe DMF also showed higher BNP levels than the patients with milder degrees of DMF.…”

Section: Conclusion and Clinical Implicationssupporting

confidence: 87%

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Kočková

Kačer

Pirk

et al. 2016

Circ J

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Background:The aim of our study was to investigate the relationship between the cardiac magnetic resonance (CMR)-derived native T1 relaxation time and myocardial extracellular volume (ECV) fraction and the extent of diffuse myocardial fibrosis (DMF) on targeted myocardial left ventricular (LV) biopsy. Methods and Results:The study population consisted of 40 patients (age 63±8 years, 65% male) undergoing valve and/or ascending aorta surgery for severe aortic stenosis (77.5%), root dilatation (7.5%) or valve regurgitation (15%). The T1 relaxation time was assessed in the basal interventricular septum pre-and 10-min post-contrast administration using the modified Look-Locker Inversion recovery sequence prior to surgery. LV myocardial biopsy specimen was obtained during surgery from the basal interventricular septal segment matched with the T1 mapping assessment. The percentage of myocardial collagen was quantified using picrosirius red staining. The average percentage of myocardial collagen was 22.0±14.8%. Both native T1 relaxation time with cutoff value ≥1,010 ms (sensitivity=90%, specificity=73%, area under the curve=0.82) and ECV with cutoff value ≥0.32 (sensitivity=80%, specificity=90%, area under the curve=0.85) showed high accuracy to identify severe (>30%) DMF. The native T1 relaxation time showed significant correlation with LV mass (P<0.01).Conclusions: Native T1 relaxation time and ECV at 10 min after contrast administration are accurate markers of DMF. (Circ J 2016; 80: 1202 -1209

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Section: Conclusion and Clinical Implicationssupporting

confidence: 87%

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Kočková

Kačer

Pirk

et al. 2016

Circ J

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“…86 A new superparamagnetic iron oxide probe conjugated to recombinant human annexin has demonstrated diffuse myocardial signal loss in rats treated with doxorubicin, suggestive of apoptosis by CMR. 87,88 Myocardial fibrosis detected as delayed enhancement (DE) by CMR has proven prognostic value in coronary heart disease, 89 and restrictive myocardial diseases including aortic stenosis, 90 hypertrophic cardiomyopathy, 91,92 and the infiltrative diseases of sarcoidosis 93 and amyloidosis. 94 CMR studies in larger populations of patients receiving potentially cardiotoxic agents are needed to see whether the presence of fibrosis detected by gadolinium enhancement identifies a cohort of patients more vulnerable to the cardiotoxic effects of chemotherapy, who may benefit from more frequent and long-term follow-up, and earlier treatment with ACE inhibitors and beta blockade to reduce the incidence and severity of chemotherapy-induced heart failure.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

Schwartz

Jain

Storozynsky

2013

Journal of Nuclear Cardiology

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The field of cardio-oncology is challenged to address an ever greater spectrum of cardiotoxicity associated with combination chemotherapy, greater dose intensity, extremes of age, and enhanced patient survival which exposes more protracted risk of developing congestive heart failure (CHF). Recent reports of chemotherapy-induced hypertension as a common adverse effect of angiogenesis inhibitors and immunosuppressants clarify the need for routine blood pressure (BP) monitoring and guideline-based management of hypertension as an integral strategy to preserve LV function. Serial monitoring of radionuclide left ventricular ejection fraction (LVEF) in adults and echocardiography in children continues to provide outcome based, cost-effective prevention of CHF in high risk patients receiving chemotherapy. To optimize treatment and monitoring strategies to eliminate late-onset LV dysfunction and CHF, traditional and novel candidate methods for assessment of chemotherapy-induced LV dysfunction are reviewed. These include serial assessment of LV volume indices by gated SPECT ERNA and gated SPECT MPI, 3D echocardiography and contrast 2D echocardiography; longitudinal strain imaging, diastolic functional parameters, 123 I-MIBG, 111 In-Antimyosin antibody imaging, and 99m Tc-Annexin V apoptosis imaging, biomarkers including troponins and BNP; genetic markers, and both functional and tissue characterization techniques with T1 weighted and T2 weighted images with cardiac magnetic resonance imaging (CMR). In our quest to optimize strategies for long-term cancer survival and prevention of CHF for patients receiving chemotherapy, rigorous modality and guideline-specific clinical outcome trials are required. A new multi-modality monitoring approach is proposed, which integrates evidencebased strengths of CMR, echocardiography, ERNA, biomarkers, and BP management for surveillance and validation of cardiotoxicity and prevention of clinical heart failure in patients receiving a broad spectrum of cancer therapies.

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“…Several recent studies measured myocardial fibrosis in this specific population, showing that its presence (identified by late gadolinium enhancement on myocardial MRI) was associated with reduced postoperative survival and its absence with significant postoperative improvement in LVEF and NYHA score [25,26]. Complementary myocardial exploration would therefore be interesting in this population in order to explore the implication of diastolic dysfunction in post-TAVI PH.…”

Section: Myocardial Fibrosis?mentioning

confidence: 99%

Clinical Impact and Prognosis of Pulmonary Hypertension after Transcatheter Aortic Valve Implantation

M¹

2014

J Cardiovasc Dis Diagn

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Background: Transcatheter Aortic Valve Implantation (TAVI) is a therapeutic option for patients presenting with severe aortic stenosis and in whom surgery is contraindicated. Pre-procedural Pulmonary Hypertension (PH) has been shown to be a factor of poor prognosis in surgical and TAVI studies. Aims:We sought to evaluate the clinical impact and prognostic implications of the presence of post-TAVI PH. Methods:The outcome of post-TAVI Pulmonary Artery Systolic Pressure (PASP) was studied in 58 high-risk patients with severe symptomatic aortic stenosis, by assessing clinical presentation and prognosis and determining predictive factors.Results: Post-TAVI PH (PASP>40 mmHg) affected 43% of patients at 6 months. Despite excellent aortic results in both groups, patients with post-TAVI PH were more symptomatic, with were severer according to the New York Heart Association classification (class III or IV), higher cardiovascular mortality and more frequent readmission for cardiac failure. On univariate analysis, factors for elevated PASP were: female sex, history ofmyocardial infarction, pacemaker implantation and permanent pacing, atrial fibrillation, and degree of mitral regurgitation. On multivariate analysis, only atrial fibrillation remained an independent factor for post-TAVI PH. Conclusion:PH is frequently present after TAVI and allows identification of a subgroup of patients with poorer clinical presentation and cardiovascular prognosis. Further studies and especially complementary myocardial investigation seem necessary.

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Prognostic Significance of Myocardial Fibrosis Quantification by Histopathology and Magnetic Resonance Imaging in Patients With Severe Aortic Valve Disease

Abstract: The amount of MF, either by histopathology or by ce-MRI, is associated with the degree of left ventricular functional improvement and all-cause mortality late after aortic valve replacement in patients with severe aortic valve disease.

Cited by 478 publications

References 34 publications

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

Clinical Impact and Prognosis of Pulmonary Hypertension after Transcatheter Aortic Valve Implantation

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Prognostic Significance of Myocardial Fibrosis Quantification by Histopathology and Magnetic Resonance Imaging in Patients With Severe Aortic Valve Disease

Abstract: The amount of MF, either by histopathology or by ce-MRI, is associated with the degree of left ventricular functional improvement and all-cause mortality late after aortic valve replacement in patients with severe aortic valve disease.

Cited by 478 publications

References 34 publications

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease – Comparison With Targeted Left Ventricular Myocardial Biopsy –

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease – Comparison With Targeted Left Ventricular Myocardial Biopsy –

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

Clinical Impact and Prognosis of Pulmonary Hypertension after Transcatheter Aortic Valve Implantation

Contact Info

Product

Resources

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Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –

Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease　– Comparison With Targeted Left Ventricular Myocardial Biopsy –