Document Detail

Myocardial Extracellular Remodeling is Associated with Ventricular Diastolic Dysfunction in Children and Young Adults with Congenital Aortic Stenosis.
MedLine Citation:
PMID:  24632273     Owner:  NLM     Status:  Publisher    
OBJECTIVES: We analyzed cardiac magnetic resonance (CMR) measurements of myocardial extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) in children and young adults with congenital aortic stenosis (AS) to determine the extent of fibrosis and examine their association with aortic valve and ventricular function.
BACKGROUND: Patients with congenital AS frequently have impaired diastolic ventricular function and exercise capacity which may be related to myocardial fibrosis.
METHODS: Thirty-five patients with congenital AS (median age 16 years) and 27 normal control subjects (median age 16 years) were evaluated by CMR. ECV was calculated from pre- and post-gadolinium contrast T1 measurements of blood and myocardium, and the hematocrit.
RESULTS: ECV was significantly higher in AS patients than normal subjects (median 0.27 (0.22-0.42) vs. 0.25 (0.18-0.27), p=0.001). LGE was present in 8 (24%) of the AS patients. A higher ECV correlated with echocardiographic indices of diastolic dysfunction including a higher mitral E-wave z-score (r=0.58, p=0.002), E/septal E' z-score (r=0.56, p=0.003), E/mean E' z-score (r=0.55, p=0.003), and indexed left atrial volume (r=0.56, p=0.001). Other factors associated with a higher ECV included a greater number of aortic valve interventions (p=0.004) and a greater number of aortic valve balloon valvuloplasties (p=0.003). ECV was not significantly associated with AS gradient, left ventricular mass, mass/volume ratio, or ejection fraction.
CONCLUSIONS: In young patients with AS, myocardial ECV is significantly elevated compared to controls and associated with echocardiographic indices of diastolic dysfunction. ECV measured by CMR may be a useful method for risk stratification and monitoring therapies targeting fibrosis.
Susan M Dusenbery; Michael Jerosch-Herold; Carsten Rickers; Steven D Colan; Tal Geva; Jane W Newburger; Andrew J Powell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-28
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  -     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-3-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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