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Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance

Andrew S Flett1, Daniel M Sado, Giovanni Quarta

  • 1The Heart Hospital, University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8PH, UK.

European Heart Journal. Cardiovascular Imaging
|May 29, 2012
PubMed

Insights

Diffuse myocardial fibrosis (DMF) is elevated in severe aortic stenosis (AS) and impacts functional capacity. Valve replacement improves AS symptoms, but does not resolve fibrosis, highlighting its prognostic significance.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomedical Engineering

Background:

  • Hemodynamics alone do not fully explain symptoms and prognosis in severe aortic stenosis (AS).
  • Myocardial disease, specifically diffuse myocardial fibrosis (DMF), may contribute to AS pathophysiology.
  • Non-invasive assessment of DMF is crucial for understanding AS progression and treatment outcomes.

Purpose of the Study:

  • To measure diffuse myocardial fibrosis (DMF) non-invasively using equilibrium contrast cardiovascular magnetic resonance (EQ-CMR) in patients with severe AS.
  • To determine the clinical significance of DMF before and after aortic valve replacement (AVR).
  • To investigate the relationship between DMF, functional capacity, and prognosis in severe AS.

Main Methods:

  • Equilibrium contrast cardiovascular magnetic resonance (EQ-CMR) was employed to quantify DMF in 63 patients with severe AS and 30 controls.
  • Patients underwent baseline and 6-month post-aortic valve replacement (AVR) assessments, including echocardiography, brain natriuretic peptide (BNP) levels, and 6-minute walk test (6MWT).
  • Multivariable analysis was used to identify predictors of functional performance.

Main Results:

  • Patients with severe AS exhibited significantly higher DMF extent compared to controls (18% vs. 13%, P=0.007), with considerable overlap.
  • DMF correlated inversely with 6-minute walk test (6MWT) performance (r²=0.22, P=0.001) and was associated with severe diastolic dysfunction (P=0.01).
  • Predictors of 6MWT performance included DMF and BNP. Four of five deaths within six months post-AVR occurred in the highest DMF tertile.

Conclusions:

  • Diffuse myocardial fibrosis (DMF), as measured by EQ-CMR, is elevated in severe aortic stenosis (AS) compared to controls, despite overlap.
  • DMF is significantly correlated with baseline functional capacity in patients with severe AS.
  • Regression of left ventricular hypertrophy post-AVR is primarily due to cellular volume reduction, not fibrosis resolution.
Abstract

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