Document Detail

Low-gradient aortic valve stenosis myocardial fibrosis and its influence on function and outcome.
MedLine Citation:
PMID:  21757118     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This prospective cohort study in patients with aortic stenosis (AS) aimed to identify surrogates of myocardial fibrosis that are easy to derive in clinical practice, allow the differentiation of low-gradient severe AS from moderate AS, and have an impact on clinical outcome.
BACKGROUND: In patients with symptomatic aortic AS, a characteristic subgroup (i.e., up to one-third) exhibits severe AS with a concomitant low mean valve gradient either with preserved or reduced ejection fraction (EF). It is hypothesized that these patients tend to have an advanced stage of myocardial fibrosis and poor clinical outcome.
METHODS: Eighty-six patients with moderate or severe AS were examined by echocardiography including conventional aortic valve assessment, mitral ring displacement, and strain-rate imaging. Replacement fibrosis was quantified by late-enhancement magnetic resonance imaging. Biopsy samples were taken from patients with severe AS (n = 69) at aortic valve replacement. All patients were followed for 9 months.
RESULTS: Patients were divided into 4 groups according to aortic valve area (<1.0 cm(2)), mean valve gradient ≥40 mm Hg, and EF (<50%): group 1, moderate AS (n = 17); group 2, severe AS/high gradient (n = 49); group 3, severe AS/low gradient/preserved EF (n = 11); and group 4, severe AS/low gradient/decreased EF (n = 9). At baseline, a significant decrease in mitral ring displacement and systolic strain rate was detected in patients with low-gradient AS. In low-gradient groups, a higher degree of interstitial fibrosis in biopsy samples and more late-enhancement magnetic resonance imaging segments were observed. A close inverse correlation was found between interstitial fibrosis and mitral ring displacement (r = -0.79, p < 0.0001). Clinical outcome was best for patients in group 1, whereas mortality risk increased substantially in groups 2 through 4.
CONCLUSIONS: In severe AS, a low gradient is associated with a higher degree of fibrosis, decreased longitudinal function, and poorer clinical outcome despite preserved EF. Mitral ring displacement differentiates between moderate AS and low-gradient/severe AS with preserved EF.
Sebastian Herrmann; Stefan Störk; Markus Niemann; Volkmar Lange; Jörg M Strotmann; Stefan Frantz; Meinrad Beer; Stefan Gattenlöhner; Wolfram Voelker; Georg Ertl; Frank Weidemann
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  58     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-07-15     Completed Date:  2011-09-29     Revised Date:  2012-03-26    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  402-12     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.
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MeSH Terms
Aortic Valve Stenosis / pathology*,  physiopathology*
Endomyocardial Fibrosis / pathology*,  physiopathology*
Middle Aged
Myocardium / pathology*
Severity of Illness Index
Comment In:
J Am Coll Cardiol. 2011 Jul 19;58(4):413-5   [PMID:  21757119 ]
J Am Coll Cardiol. 2012 Feb 21;59(8):777; author reply 778   [PMID:  22340274 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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