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HISTOPATHOLOGICAL MYOCARDIAL CHANGES IN PATIENTS WITH SEVERE AORTIC STENOSIS REFERRED FOR SURGICAL VALVE REPLACEMENT: A CMR CORRELATION STUDY
Session:
Sessão de Posters 55 - RM Cardíaca
Speaker:
Rita Reis Santos
Congress:
CPC 2024
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.6 Cross-Modality and Multi-Modality Imaging Topics
Session Type:
Cartazes
FP Number:
---
Authors:
Rita Reis Santos; João Abecasis; Pedro Lopes; Sergio Maltes; António Ferreira; Regina Ribeiras; Maria João Andrade; Miguel Sousa Uva; Victor Gil; Ana Félix; Sancia Ramos; Nuno Cardim
Abstract
<p style="text-align:center"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong>Background:</strong> Myocardial fibrosis (MF) takes part in left ventricular (LV) remodeling in patients with aortic stenosis (AS), driving the transition from hypertrophy to heart failure. The structural events that occur in this transition are not fully enlightened.</span></span></span></p> <p style="text-align:center"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong>Aim: </strong>to describe histopathology changes at endomyocardial biopsy (EMB) in patients with severe AS referred to surgical aortic valve replacement (AVR); to correlate them with LV tissue characterization from pre-operative cardiac magnetic resonance (CMR).</span></span></span></p> <p style="text-align:center"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong>Methods: </strong><span style="color:black">one-hundred-fifty-eight patients (</span>73[68-77]years, 50%women)<span style="color:black"> referred for surgical AVR because of severe symptomatic AS, with pre-operative CMR (n=143) with late gadolinium enhancement (LGE), T1, T2 mapping and extracellular volume fraction (ECV) quantification. Intra-operative septal EMB was obtained in 129 patients. MF was assessed through<em> Masson´s Trichrome</em> histochemistry. Immunohistochemistry was performed for both inflammatory cells and extracellular matrix (ECM) characterization (Type I Collagen, Fibronectin, Tenascin C).</span></span></span></span></p> <p style="text-align:center"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong><span style="color:black">Results: </span></strong><span style="color:black">non-ischemic LGE </span>was present in 106 patients (67.1%) (median fraction: 5.0% [2.0-9.7]). Native T1 was above normal: 1053ms[1024-1071] and T2 within normal range (39.3ms[37.3-42.0]). Median MF was 11.9%[6.54-19.97], with predominant type I collagen perivascular distribution (95.3%). Subendocardial cardiomyocyte ischemic-like changes were identified in 45% of EMB. There was no inflammation, despite ECM remodeling expression. MF quantification at EMB was correlated with LGE mass and indexed ECV (p=0.008; p=0.017, respectively).</span></span></span></p> <p style="text-align:center"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:medium"><span style="color:#000000"><strong>Conclusion: </strong>patients with severe symptomatic AS referred for surgical AVR have unspecific histological myocardial changes, including signs of cardiomyocyte ischemic insult. ECM remodeling is ongoing, with MF heterogeneity. These features may be <span style="color:black">recognized</span><span style="color:black"> by comprehensive CMR involving LGE, T1 mapping derived indexes and their combination with LV morphofunctional characterization.</span></span></span></span></p>
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