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Late gadolinium enhancement patterns in severe symptomatic high-gradient aortic stenosis
Session:
Comunicações Orais (Sessão 11) - Imagem 1 - TC e RM Cardíaca e Cardiologia Nuclear
Speaker:
Sérgio Maltês
Congress:
CPC 2022
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.3 Cardiac Magnetic Resonance
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; João Abecasis; Rita Reis Santos; Luís Oliveira; Gustavo sá Mendes; Sara Guerreiro; Telma Lima; Pedro Freitas; António Ferreira; Nuno Cardim; Vitor Gil; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Left ventricular (LV) remodeling in patients with severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response and may involve reparative/replacement fibrosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for detecting focal myocardial fibrosis through late gadolinium enhancement (LGE). However, myocardial fibrosis prevalence and distribution is quite variable among series. Our goal was to assess LGE prevalence and distribution pattern in severe symptomatic high-gradient AS.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Methodology</u><span style="color:#222222">: Single-center prospective cohort of 132 patients with severe symptomatic high-gradient AS (mean age 73 ± 11 years; 48% male, mean valvular transaortic gradient 60 ± 20 mmHg; mean aortic valve area 0.7 ± 0.2 cm<sup>2</sup>/m<sup>2</sup>; mean LV ejection fraction by 2D echocardiogram 58 ± 9%), all with normal flow (except one) undergoing surgical aortic valve replacement.</span> <span style="color:#222222">Those with previous history of myocardial infarction or other cardiomyopathy were excluded. </span><span style="color:#222222">All patients performed 1.5T CMR assessment with LV myocardium tissue characterization prior to surgery. Segmental LGE presence was assessed by two independent operators and classified according to the AHA 16 segment model, using 5-standard deviations from remote myocardium as the signal intensity cut-off for LGE identification and quantification.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Results</span></u><span style="color:#222222">: Overall, 96 patients (74%) had non-ischemic LGE (median LGE mass 3.2g [IQR 0.2-8.3]g; median percentage of LGE myocardial mass 2.5% [IQR 0.1-6.1]%); 22 patients [17%] with exclusively junctional LGE); in one patient an incidental ischemic scar (subendocardial distribution) was identified. No cases of subepicardial distribution were found. Intramyocardial LGE was most frequently observed in basal and mid-anterior and inferior interventricular septum - see </span><strong><span style="color:#4472c4">figure 1</span></strong><span style="color:#222222">. In these segments, LGE was most often junctional at right-ventricular insertion points (54%), followed by mid-wall LGE (32%) or both sites involvement (14%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><u><span style="color:#222222">Conclusion</span></u><span style="color:#222222">: LGE is frequent in symptomatic high-gradient AS patients with preserved left ventricular ejection fraction, most often presenting as junctional enhancement in basal/mid-anterior and inferior interventricular septum. Future studies may address whether distinct LGE patterns may impact patient prognosis.</span></span></span></span></p>
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