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Progression of hypertrophy and myocardial fibrosis in aortic stenosis: a multicenter cardiac magnetic resonance study

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dc.contributor.author Everett, Russell J.
dc.contributor.author Tastet, Lionel
dc.contributor.author Clavel, Marie-Annick
dc.contributor.author Chin, Calvin W.L.
dc.contributor.author Capoulade, Romain
dc.contributor.author Vassiliou, Vassilios S.
dc.contributor.author Kwiecinski, Jacek
dc.contributor.author Gómez Pérez, Miguel Angel
dc.contributor.author van Beek, Edwin J.R.
dc.contributor.author White, Audrey C.
dc.contributor.author Prasad, Sanjay K.
dc.contributor.author Larose, Eric
dc.contributor.author Tuck, Christopher
dc.contributor.author Semple, Scott
dc.contributor.author Newby, David E.
dc.contributor.author Pibarot, Philippe
dc.contributor.author Dweck, Marc R.
dc.date.accessioned 2019-03-26T09:41:10Z
dc.date.available 2019-03-26T09:41:10Z
dc.date.issued 2018
dc.identifier.citation Everett RJ, Tastet L, Clavel MA, Chin CWL, Capoulade R, Vassiliou VS. et al. Progression of hypertrophy and myocardial fibrosis in aortic stenosis: a multicenter cardiac magnetic resonance study. Circ Cardiovasc Imaging. 2018 Jun;11(6):e007451. DOI: 10.1161/CIRCIMAGING.117.007451
dc.identifier.issn 1941-9651
dc.identifier.uri http://hdl.handle.net/10230/36967
dc.description.abstract BACKGROUND: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. We investigated the natural history of these processes in asymptomatic patients and their potential reversal post-aortic valve replacement (AVR). METHODS: Asymptomatic and symptomatic patients with aortic stenosis underwent repeat echocardiography and magnetic resonance imaging. Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis (indexed extracellular volume), and replacement fibrosis (late gadolinium enhancement [LGE]) were quantified. RESULTS: In 61 asymptomatic patients (43% mild, 34% moderate, and 23% severe aortic stenosis), significant increases in peak aortic-jet velocity, left ventricular mass index, indexed extracellular volume, and LGE mass were observed after 2.1±0.7 years, with the most rapid progression observed in patients with most severe stenosis. Patients with baseline midwall LGE (n=16 [26%]; LGE mass, 2.5 g [0.8-4.8 g]) demonstrated particularly rapid increases in scar burden (78% [50%-158%] increase in LGE mass per year). In 38 symptomatic patients (age, 66±8 years; 76% men) who underwent AVR, there was a 19% (11%-25%) reduction in left ventricular mass index (P<0.0001) and an 11% (4%-16%) reduction in indexed extracellular volume (P=0.003) 0.9±0.3 years after surgery. By contrast midwall LGE (n=10 [26%]; mass, 3.3 g [2.6-8.0 g]) did not change post-AVR (n=10; 3.5 g [2.1-8.0 g]; P=0.23), with no evidence of regression even out to 2 years. CONCLUSIONS: In patients with aortic stenosis, cellular hypertrophy and diffuse fibrosis progress in a rapid and balanced manner but are reversible after AVR. Once established, midwall LGE also accumulates rapidly but is irreversible post valve replacement. Given its adverse long-term prognosis, prompt AVR when midwall LGE is first identified may improve clinical outcomes.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher Lippincott Williams & Wilkins
dc.rights © 2018 The Authors. Circulation: Cardiovascular Imaging is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, https://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.
dc.subject.other Fibrosi cardíaca
dc.title Progression of hypertrophy and myocardial fibrosis in aortic stenosis: a multicenter cardiac magnetic resonance study
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.1161/CIRCIMAGING.117.007451
dc.subject.keyword Aortic valve stenosis
dc.subject.keyword Fibrosis
dc.subject.keyword Gadolinium
dc.subject.keyword Hypertrophy
dc.subject.keyword Magnetic resonance imaging
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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