| Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. | |
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MedLine Citation:
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PMID: 22634740 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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AIMS: Haemodynamics alone do not fully explain symptoms and prognosis in clinically severe aortic stenosis (AS). Myocardial disease, specifically diffuse myocardial fibrosis (DMF), may contribute. We used equilibrium contrast cardiovascular magnetic resonance (EQ-CMR) and sought to non-invasively measure DMF in severe AS and determine its clinical significance before and after valve replacement. METHODS AND RESULTS: Patients with severe AS underwent echocardiography, brain natriuretic peptide (BNP), 6 min walk test (6MWT), and EQ-CMR pre- (n = 63) at baseline and at 6 months post- (n = 42) aortic valve replacement (AVR). EQ-CMR was also performed in 30 normal controls. Baseline: patients with AS had more DMF than controls (18 vs. 13%, P = 0.007) with a wide range (5-38%) that overlapped controls. The extent of diffuse fibrosis correlated inversely with the 6MWT performance (r(2) = 0.22, P = 0.001). Those with severe diastolic dysfunction had more DMF (P = 0.01). On multivariable analysis, the predictors of performance at 6MWT were diffuse fibrosis and BNP (P = 0.003 and 0.02, respectively). Post-op: following valve replacement, morphological and functional parameters improved [6 MWT, LA area, BNP, left ventricular (LV) hypertrophy, and volumes]. LV hypertrophy regression was shown to be cell volume reduction (P < 0.001) and not fibrosis regression (P = 0.54). Of the five deaths over six-month follow-up, four occurred in patients in the highest tertile of DMF. CONCLUSION: DMF as measured by EQ-CMR is elevated in severe AS vs. normal controls but with a considerable overlap. It correlates with functional capacity at baseline. LV hypertrophy regression 6 months after AVR is cellular rather than fibrosis resolution. |
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Authors:
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Andrew S Flett; Daniel M Sado; Giovanni Quarta; Mariana Mirabel; Denis Pellerin; Anna S Herrey; Derek J Hausenloy; Cono Ariti; John Yap; Shyam Kolvekar; Andrew M Taylor; James C Moon |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-5-25 |
Journal Detail:
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Title: European heart journal cardiovascular Imaging Volume: - ISSN: 2047-2412 ISO Abbreviation: Eur Heart J Cardiovasc Imaging Publication Date: 2012 May |
Date Detail:
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Created Date: 2012-5-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101573788 Medline TA: Eur Heart J Cardiovasc Imaging Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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The Heart Hospital, University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8PH, UK. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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