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LV replacement fibrosis in Aortic stenosis: prevalence and relation to LV remodelling and function
Session:
Sessão de Comunicações Orais - Doença Valvular
Speaker:
Gustavo Sá Mendes
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.1 Valvular Heart Disease – Pathophysiology and Mechanisms
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Gustavo Sá Mendes; João Abecasis; António Miguel Ferreira; Regina Ribeiras; Carla Rodrigues Carvalho; Sara Guerreiro; Eduarda Horta; Carolina Padrão; Victor M. Gil; Miguel Mendes; José Pedro Neves
Abstract
<p><strong>Background:</strong> Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).</p> <p><strong>Aim:</strong> To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis.</p> <p><strong>Methods: </strong>We prospectively studied 53 consecutive patients (age: 71± 8 years [min. 51- max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6 - 63.2] and aortic valve area 0.74cm<sup>2 </sup>[IQR 0.61 - 0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification - using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE.</p> <p><strong>Results: </strong>Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9-12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028-1084]; 22% [IQR 18-25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3-70.8%] (11 patients with reduced EF) and 76.5g/m<sup>2 </sup>[IQR 57.4-94.8g/m<sup>2</sup>], respectively. Median GLS was -13.9% [IQR -11.4 - -17.0%] and torsion was 24.2<sup>o </sup>[IQR 19.8-32.5<sup>o</sup>]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m<sup>2</sup>, p=0.001), worse GLS (-14.4% vs -16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure).</p> <p><strong>Conclusions: </strong>Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease.</p>
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