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Predictors of myocardial fibrosis in severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF)
Session:
Posters 3 - Écran 08 - Imagiologia Cardíaca
Speaker:
Cláudio Guerreiro
Congress:
CPC 2018
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Ressonance
Session Type:
Posters
FP Number:
---
Authors:
CM Espada Guerreiro; Jennifer Mâncio; Nuno Dias Ferreira; David Monteiro; Ricardo Ladeiras-Lopes; Rita Faria; Nuno Almeida; Pedro Rodrigues; Wilson Ferreira; Mónica Carvalho; Luís Vouga; Vasco Gama Ribeiro; Nuno Bettencourt
Abstract
<p><strong>Introduction</strong></p> <p>Myocardial fibrosis can have an adverse impact on clinical outcome after AVR, which can be indirectly assessed by LGE in CMR imaging. Silent ischaemia and infarction can contribute to replacement fibrosis, influencing the treatment strategy and prognosis of AS patients.</p> <p> </p> <p><strong>Objectives </strong></p> <p>To evaluate the severity and pattern of distribution of LGE in AS patients. To investigate the impact of ischaemia in LV replacement fibrosis.</p> <p> </p> <p><strong>Methods</strong></p> <p>Prospective cohort of 53 severe AS patients referred for AVR that underwent CMR. LGE was performed to analyse the severity and pattern of distribution of replacement fibrosis. Patients were stratified according to the number of involved segments: no fibrosis (0 segments), mild LGE+ (1 LGE positive segment) and severe LGE+ (at least 2 segments). Ischaemia was investigated using adenosine stress imaging. Obstructive CAD was defined by invasive coronary angiography as at least one coronary stenosis ≥50%.</p> <p> </p> <p><strong>Results</strong></p> <p>53 patients (age 71±9 years; 64% males) underwent CMR before AVR; adenosine stress imaging was safe in all, but one patient had heart failure decompensation. Prior AMI was known in only one patient. Obstructive CAD was observed in 20 patients (37.7%).</p> <p>28 patients (52.8%) had no myocardial fibrosis, 10 (18.9%) had mild LGE+ and the remaining 15 had severe LGE+ (28.3%). Overall, the majority of LGE+ segments were mid-wall (N=13, 52%), followed by a subendocardial pattern (N=10, 40%). </p> <p>There was trend towards higher ischaemic burden in CMR in severe LGE patients (ischaemic segments 4.6 vs. 0.8 vs. 1.5, P=0.07), predominantly in mid segments (1.9 vs. 0.5 vs. 0.4, P=0.05). The pattern of fibrosis in severe LGE+ patients was predominantly mid-wall (53.3%) and mainly located in the basal segments (basal 1.4 vs. mid 1.0 vs. apical 0.2 segments).</p> <p>Patients with severe LGE+ did not differ regarding LV mass (no fibrosis 151±61 vs. 152±43 vs. 184±52, p=0.18). However, by TTE LVM was higher in patients with severe LGE+ (261±62 vs. 230±84 vs. 198±54, p=0.03). They had higher LV volumes (EDLVV 166±37 vs. 161±58 vs. 140±33, P=<em>NS</em>; ESLVV 69±19 vs. 63±40 vs. 49±17, p=0.03) and lower EF (58±7 vs. 62±8 vs. 65±7%, p=0.03). Septal and lateral EE’ were higher (lateral 15±4.5 vs. 15±9.7 vs. 10±3.8, p=0.04), which can be related with diastolic dysfunction.</p> <p>After adjustment for age, BMI, arterial HTN, diabetes, LV volumes and mass, the presence of CAD in invasive angiography was associated with higher burden of severe LGE+ segments (OR 15, 95% CI 1-234, p=0.04).</p> <p> </p> <p><strong>Conclusions</strong></p> <p>Severe LGE+ was associated with higher LV mass, volume, systolic dysfunction, and a sign towards higher prevalence of diastolic dysfunction. Obstructive CAD was a independent predictor of severe LGE+. Vasodilator stress with adenosine was safe, and it might be useful in risk stratification of AS patients. Further studies are needed to confirm the incremental prognostic value of myocardial perfusion by CMR in this population.</p>
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