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.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.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.doi http://dx.doi.org/10.1161/CIRCIMAGING.117.007451
• dc.identifier.issn 1941-9651
• dc.identifier.uri http://hdl.handle.net/10230/36967
• dc.language.iso eng
• dc.publisher Lippincott Williams & Wilkins
• dc.relation.ispartof Circulation: Cardiovascular Imaging. 2018 Jun;11(6):e007451
• 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.rights.accessRights info:eu-repo/semantics/openAccess
• 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.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.type.version info:eu-repo/semantics/publishedVersion