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Published on: October 20, 2023
Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis
Vitor E E Rosa1, Henrique B Ribeiro1, Roney O Sampaio1
1Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.).
Patients with low-flow, low-gradient aortic stenosis (LFLG-AS) show increased myocardial fibrosis compared to high-gradient aortic stenosis. Diffuse fibrosis does not appear to be the primary cause of absent left ventricular flow reserve (FR) in LFLG-AS.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac MRI
Background:
- Limited data exists on myocardial fibrosis in low-flow, low-gradient aortic stenosis (LFLG-AS).
- The relationship between interstitial fibrosis and left ventricular flow reserve (FR) in LFLG-AS is not well understood.
Purpose of the Study:
- To assess diffuse interstitial myocardial fibrosis using T1 mapping cardiac magnetic resonance (CMR).
- To evaluate the association between myocardial fibrosis and left ventricular flow reserve (FR) in LFLG-AS patients.
Main Methods:
- Prospective study of 65 patients (41 LFLG-AS, 24 high-gradient AS controls).
- Dobutamine stress echocardiography was used to assess FR.
- Cardiac MRI determined extracellular volume (ECV) fraction, indexed ECV (iECV), and late gadolinium enhancement (LGE).
Main Results:
- LFLG-AS patients exhibited higher iECV compared to high-gradient AS controls (P<0.001).
- No significant difference in ECV or iECV was found between LFLG-AS patients with and without FR (P=0.950 and P=0.701).
- LGE mass was similar in LFLG-AS patients with and without FR, but higher than in controls (P=0.018).
Conclusions:
- LFLG-AS is associated with increased myocardial fibrosis (ECV, iECV, LGE) compared to high-gradient AS.
- Myocardial fibrosis degree is similar in LFLG-AS patients with or without FR.
- Diffuse myocardial fibrosis may not be the primary driver of absent FR in LFLG-AS.
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