Short-term adverse remodeling progression in asymptomatic aortic stenosis

Area of Science:

• Cardiology
• Medical Imaging
• Cardiac Remodeling

Background:

• Aortic stenosis (AS) often has a prolonged asymptomatic phase.
• Current guidelines suggest delaying intervention until symptom onset in severe AS.
• Assessing subclinical disease progression is crucial for optimal management.

Purpose of the Study:

• To evaluate the progression of adverse cardiac remodeling in asymptomatic patients with moderate to severe aortic stenosis (AS).
• To utilize cardiovascular magnetic resonance imaging (MRI) for detailed assessment of cardiac changes.
• To identify potential indicators for earlier intervention strategies in AS.

Main Methods:

• Prospective, multi-center observational study (PRIMID-AS) of asymptomatic patients with moderate-severe AS.
• Repeat cardiac MRI performed at 12 months on participants who remained asymptomatic.
• Analysis included left ventricular (LV) and left atrial volumes, LV ejection fraction, strain rate, LV mass, late gadolinium enhancement (LGE), extracellular volume, and NT-proBNP levels.

Main Results:

• Significant increases observed in indexed LV and left atrial volumes.
• A decrease in systolic (LV ejection fraction) and diastolic function was noted.
• Late gadolinium enhancement (LGE) nearly doubled, indicating increased scar burden, despite stable LV mass.
• NT-proBNP levels also significantly increased.

Conclusions:

• Cardiac remodeling and scar burden (LGE) progress even in asymptomatic severe aortic stenosis (AS).
• The lack of LGE reversibility post-aortic valve replacement (AVR) and its association with mortality suggest potential benefit from earlier intervention.
• Findings support re-evaluation of current guidelines and highlight the need for improved risk stratification in AS management.