Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients.
نویسندگان
چکیده
Aims To investigate myocardial fibrosis (MF) in a large series of severe aortic stenosis (AS) patients using invasive biopsy and non-invasive imaging. Methods and results One hundred thirty-three patients with severe, symptomatic AS accepted for surgical aortic valve replacement underwent cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume fraction (ECV) quantification. Intra-operative left ventricular (LV) biopsies were performed by needle or scalpel, yielding tissue with (n = 53) and without endocardium (n = 80), and compared with 10 controls. Myocardial fibrosis occurred in three patterns: (i) thickened endocardium with a fibrotic layer; (ii) microscopic scars, with a subendomyocardial predominance; and (iii) diffuse interstitial fibrosis. Collagen volume fraction (CVF) was elevated (P < 0.001) compared with controls, and higher (P < 0.001) in endocardium-containing samples with a decreasing CVF gradient from the subendocardium (P = 0.001). Late gadolinium enhancement correlated with CVF (P < 0.001) but not ECV. Both LGE and ECV correlated independently (P < 0.001) with N-terminal pro-brain natriuretic peptide and high-sensitivity-troponin T. High ECV was also associated with worse LV remodelling, left ventricular ejection fraction and functional capacity. Combining high ECV and LGE better identified patients with more adverse LV remodelling, blood biomarkers and histological parameters, and worse functional capacity than each parameter alone. Conclusion Myocardial fibrosis in severe AS is complex, but three main patterns exist: endocardial fibrosis, microscars (mainly in the subendomyocardium), and diffuse interstitial fibrosis. Neither histological CVF nor the CMR parameters ECV and LGE capture fibrosis in its totality. A combined, multi-parametric approach with ECV and LGE allows best stratification of AS patients according to the response of the myocardial collagen matrix.
منابع مشابه
Non-invasive estimation of cardiac wall stress by using tissue doppler-echocardiography ultrasound images: People with coronary artery stenosis
In this study, a method for non-invasive estimation of stress on the heart wall in the diastole phase is presented using ultrasound echocardiography and tissue Doppler imaging. The aim of this study was to evaluate the stress on the heart wall as a pre-diagnosis to identify people with coronary artery stenosis. 29 patients with stenosis of more than 70%, 30 patients with stenosis of 50 to 7...
متن کاملT1 values by conservative septal postprocessing approach are superior in relating to the interstitial myocardial fibrosis: findings from patients with severe aortic stenosis
Background Accumulation of diffuse interstitial myocardial fibrosis in severe aortic stenosis relates to left ventricular (LV) functional impairment and determines the postoperative outcome in these patients. T1 mapping has been proposed for non-invasive quantification of diffuse interstitial fibrosis. We examined associations between T1 values and collagen volume fraction from endomyocardial b...
متن کاملT1 mapping in severe aortic stenosis: insights into LV remodeling
Background Aortic stenosis (AS) appears to be not just a disease of the valve, with adaptive and maladaptive myocardial remodeling playing a key role. Left ventricular (LV) remodeling in AS is characterized by cellular hypertrophy and diffuse myocardial fibrosis. Macroscopic patterns differ between patients: as hypertrophy increases, the pattern changes from normal to concentric remodeling, con...
متن کاملEvaluation of myocardial fibrosis with cardiac magnetic resonance contrast-enhanced t1 mapping in adults patients with aortic stenosis
Background Development of diffuse myocardial fibrosis in aortic stenosis (AS) has been associated with an adverse prognosis. Measurement of extracellular volume (ECV) from T1 mapping contrast magnetic resonance (CMR), has been recently validated as a non-invasive method for assessment of such diffuse myocardial fibrosis.Our objective was to evaluate the functional consequences of diffuse myocar...
متن کاملHistological Validation of measurement of diffuse interstitial myocardial fibrosis by myocardial extravascular volume fraction from Modified Look-Locker imaging (MOLLI) T1 mapping at 3 T
BACKGROUND Gadolinium (Gd) Extracellular volume fraction (ECV) by Cardiovascular Magnetic Resonance (CMR) has been proposed as a non-invasive method for assessment of diffuse myocardial fibrosis. Yet only few studies used 3 T CMR to measure ECV, and the accuracy of ECV measurements at 3 T has not been established. Therefore the aims of the present study were to validate measurement of ECV by MO...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- European heart journal
دوره 39 8 شماره
صفحات -
تاریخ انتشار 2018