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Histology-verified myocardial fibrosis in severe AS patients: prevalence and correlation with non-invasive LV myocardial tissue assessment
Session:
Comunicações Orais (Sessão 17) - Ciência Básica e Saúde Digital
Speaker:
Sérgio Maltês
Congress:
CPC 2022
Topic:
O. Basic Science
Theme:
36. Basic Science
Subtheme:
36.3 Basic Science - Cardiac Diseases
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Maltês; João Abecasis; Daniel Gomes Pinto; Rita Reis Santos; Pedro md Lopes; Gustavo sá Mendes; Sara Guerreiro; Telma Lima; Pedro Freitas; António Ferreira; Sância Ramos; Ana Félix; Nuno Cardim; Victor Gil; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u>Background</u>: Myocardial fibrosis (MF) is a common finding and a potential adverse prognostic marker in several cardiac diseases, including in severe aortic stenosis (AS). While histological analysis obtained through endomyocardial biopsy remains the gold-standard for MF assessment, non-invasive cardiac imaging may offer surrogate biomarkers for fibrosis. We tried to assess the correlation between MF quantification at histopathology and cardiac magnetic resonance (CMR)-derived tissue characterization data in patients with severe 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 enrolling 71 patients with severe symptomatic high-gradient AS undergoing surgical aortic valve replacement (SAVR) (mean age 71 ± 9 years; 49% male, mean valvular transaortic gradient 60 ± 20 mmHg; mean left ventricle [LV] ejection fraction by CMR 58 ± 9%).</span> <span style="color:#222222">Those with past history of myocardial infarction or other cardiomyopathy were excluded.</span> <span style="color:#222222">All patients underwent pre-operative CMR study with LV tissue characterization and quantification. Elevated T1 mapping was defined as a value >1021ms as per center protocol. </span><span style="background-color:white"><span style="color:black">Myocardial tissue was obtained during SAVR either through biopsy at basal LV septum or harvested from surgical myectomy specimens. Masson´s trichrome stain was used for collagen/fibrosis assessment. Automatic quantification was obtained at <em>QuPath<sup>TM</sup> </em>digital pathology software after applying a dedicated artificial intelligence algorithm on ultra-high-resolution digital slide scanning images (<em>Aperio AT2 brightfield scanner<sup>TM</sup></em>).</span></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">: Histology-confirmed MF was observed in all patients (median percentage of fibrotic myocardial tissue 15% [IQR 9-22%]).</span><span style="color:black"> Median global T1 mapping and extracellular volume (ECV) percentage was 1048ms (IQR 1027-1078) and 24% (IQR 20-30%), respectively. Late gadolinium enhancement (LGE) with a non-ischemic pattern was present in 42 patients (59%) with a median LGE mass of 5.8g [IQR 1.0-10.2]; median percentage of LV mass with LGE 3.7% [IQR 0.6-10.4]. While neither T1 mapping (global or basal LV septum), ECV nor LGE had any significant correlation with histology-confirmed MF (</span><strong><span style="color:#4472c4">figure 1</span></strong><span style="color:black">), the vast majority of patients had significantly elevated global and basal LV septum T1 mapping – 81% and 92%, respectively.</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">: In this single-center prospective study, microscopic MF was present in all patients with </span>severe symptomatic high-gradient AS, was accompanied by elevated T1 mapping values but no correlation was found between myocardial fibrosis at histopathology analysis and CMR-derived LV <span style="color:#222222">tissue characterization parameters. This may not only stem from sampling (single point biopsy vs. whole myocardial tissue assessment) but also from distinct evaluation of different types of fibrosis by different methods. </span></span></span></span></p>
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