Progression of Hypertrophy and Myocardial Fibrosis in Aortic Stenosis: A Multicenter Cardiac Magnetic Resonance Study. (June 2018)

• Record Type: Journal Article
• Authors: Everett, Russell J.; Tastet, Lionel; Clavel, Marie-Annick; Chin, Calvin W.L.; Capoulade, Romain; Vassiliou, Vassilios S.; Kwiecinski, Jacek; Gomez, Miquel; van Beek, Edwin J.R.; White, Audrey C.; Prasad, Sanjay K.; Larose, Eric; Tuck, Christopher; Semple, Scott; Newby, David E.; Pibarot, Philippe; Dweck, Marc R.
• Is Part Of: Circulation. Volume 11:Number 6(2018)
• Publication Date: 2018-06
• Subjects: aortic valve stenosis -- fibrosis -- gadolinium -- hypertrophy -- magnetic resonance imaging; Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.1075405
• DOI: 10.1161/CIRCIMAGING.117.007451
• Languages: English
• ISSNs: 1941-9651

Abstract

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. Clinical Trial Registration: URL:https://www.clinicaltrials.gov . Unique identifiers: NCT01755936 and NCT01679431. Abstract : Supplemental Digital Content is available in the text.