![[feed]](/style/images/feed-icon-14x14.png){kind=icon}
Tools
Tools
Preview |
PDF (Original Article)
- Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
1MB |
| Item Type: | Article |
|---|---|
| Title: | Extracellular myocardial volume in patients with aortic stenosis |
| Creators Name: | Everett, R.J., Treibel, T.A., Fukui, M., Lee, H., Rigolli, M., Singh, A., Bijsterveld, P., Tastet, L., Musa, T.A., Dobson, L., Chin, C., Captur, G., Om, S.Y., Wiesemann, S., Ferreira, V.M., Piechnik, S.K., Schulz-Menger, J., Schelbert, E.B., Clavel, M.A., Newby, D.E., Myerson, S.G., Pibarot, P., Lee, S., Cavalcante, J.L., Lee, S.P., McCann, G.P., Greenwood, J.P., Moon, J.C. and Dweck, M.R. |
| Abstract: | BACKGROUND: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis. OBJECTIVES: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes. METHODS: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery-based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters. RESULTS: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013). CONCLUSIONS: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality. |
| Keywords: | Aortic Stenosis, Cardiovascular Magnetic Resonance, Diffuse Myocardial Fibrosis, T1 Mapping |
| Source: | Journal of the American College of Cardiology |
| ISSN: | 0735-1097 |
| Publisher: | Elsevier |
| Volume: | 75 |
| Number: | 3 |
| Page Range: | 304-316 |
| Date: | 28 January 2020 |
| Official Publication: | https://doi.org/10.1016/j.jacc.2019.11.032 |
| PubMed: | View item in PubMed |
Repository Staff Only: item control page
