169 Mid-wall fibrosis is an independent predictor of mortality in patients with aortic stenosis. (9th June 2011)

• Record Type: Journal Article
• Authors: Dweck, M R; Joshi, S; Murigu, T; Gulati, A; Alpendurado, F; Mohiaddin, R; Pepper, J; Pennell, D; Newby, D; Prasad, S
• Is Part Of: Heart. Volume 97(2011)Supplement 1
• Page Start: A94
• Page End: A94
• Publication Date: 2011-06-09
• Subjects: Aortic stenosis -- Cardiovascular MRI -- late gadolinium enhancement; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2011-300198.169
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Introduction: Predicting adverse clinical outcomes in aortic stenosis is challenging. Late gadolinium enhancement (LGE) has been associated with an adverse prognosis in a range of other cardiac conditions. Using late gadolinium enhancement, we sought to assess the prognostic significance of mid-wall and infarct patterns of myocardial fibrosis in aortic stenosis. Methods: Between January 2003 and October 2008, consecutive patients with moderate or severe aortic stenosis (aortic valve area <1.5 cm 2 ) underwent cardiovascular magnetic resonance with assessment of myocardial fibrosis by late gadolinium enhancement. Patients were categorised into absent, mid-wall or infarct patterns of late gadolinium enhancement by blinded independent observers. Patient follow-up was completed using the National Strategic Tracing Scheme. Results: 143 patients (aged 68±14 years; 97 male) were followed up for 2.0±1.4 years. 81 patients had coronary artery disease, 72 underwent aortic valve replacement and 27 died. Compared to those with no late gadolinium enhancement (n=49), univariate analysis revealed that patients with mid-wall fibrosis (n=54) had an eightfold increase in all-cause mortality despite similar aortic stenosis severity and coronary artery disease burden. Patients with an infarct pattern (n=40) had a six-fold increase. Mid-wall fibrosis (HR, 5.35 (95% CI, 1.16 to 24.56); p=0.03) and ejection fraction (HR 0.96 (95% CI, 0.94 to 0.99); p=0.01) were independent predictors of all cause mortality by multivariate analysis. Conclusion: Mid-wall fibrosis is an independent predictor of mortality in patients with moderate and severe aortic stenosis. It has incremental prognostic value to ejection fraction and may provide a useful method of risk stratification in patients with advanced disease (Abstract 169 figure 1 ).