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Exploring myocardial fibrosis in severe aortic stenosis: echo, CMR and histology data from FIB-AS study

Giedrė Balčiūnaitė1, Justinas Besusparis2, Darius Palionis2

  • 1Vilnius University: Vilniaus Universitetas, Vilnius, Lithuania. dr.giedre.balciunaite@gmail.com.

The International Journal of Cardiovascular Imaging
|March 3, 2022
PubMed

Insights

Myocardial fibrosis in aortic stenosis (AS) is linked to poor outcomes after aortic valve replacement. Advanced cardiac remodeling in AS patients can be identified using global longitudinal strain (GLS) and native T1 mapping.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Cardiac Pathology

Background:

  • Myocardial fibrosis is a key factor in the adverse outcomes of patients with aortic stenosis (AS).
  • Understanding the extent and impact of myocardial fibrosis is crucial for predicting survival after aortic valve replacement (AVR).

Purpose of the Study:

  • To assess myocardial fibrosis in patients with severe AS.
  • To integrate echocardiographic, cardiovascular magnetic resonance (CMR), and histological data to evaluate fibrosis.
  • To identify imaging biomarkers for fibrosis and adverse cardiac remodeling.

Main Methods:

  • Eighty-three severe AS patients underwent CMR (late gadolinium enhancement, T1 mapping) and global longitudinal strain (GLS) analysis before AVR.
  • Myocardial biopsies were obtained during AVR for collagen volume fraction (CVF) measurement.
  • Correlation analysis was performed between imaging parameters, histology, and serum biomarkers.

Main Results:

  • Collagen volume fraction (CVF) correlated with left ventricular (LV) dysfunction, chamber enlargement, and was higher in the sub-endocardium.
  • CVF was significantly higher in patients with late gadolinium enhancement (LGE) positive findings.
  • Global longitudinal strain (GLS) showed significant inverse correlations with both invasively measured CVF and non-invasively measured native T1 values.

Conclusions:

  • Myocardial fibrosis plays a critical role in the adverse cardiac remodeling observed in AS.
  • Global longitudinal strain (GLS) shows promise as a non-invasive surrogate marker for myocardial fibrosis.
  • Elevated native T1 and reduced GLS values can indicate more advanced cardiac remodeling in AS patients.

Keywords:
Aortic stenosisCardiovascular magnetic resonanceGlobal longitudinal strainMyocardial fibrosisT1 mapping

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