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LGE prevalence and patterns in severe aortic stenosis: When "junctional" means the same
Sérgio Maltês1, João Abecasis2, Rita Reis Santos1
1Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
International Journal of Cardiology
|February 24, 2023
Summary
In severe aortic valve stenosis, cardiac fibrosis (LGE) is common, particularly in the septum. Non-junctional fibrosis indicates worse left ventricular remodeling and prognosis.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Pathology
Background:
- Left ventricular (LV) remodeling in severe aortic valve stenosis (AS) involves more than hypertrophy.
- Reparative/replacement fibrosis is irreversible and crucial for risk stratification.
- Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is the gold standard for fibrosis detection.
Purpose of the Study:
- To assess the prevalence and patterns of LGE in severe AS.
- To investigate the relationship between LGE patterns and LV remodeling markers.
Main Methods:
- Prospective cohort study of 140 patients with severe symptomatic high-gradient AS.
- LGE-CMR performed prior to surgical aortic valve replacement.
- Exclusion of patients with prior myocardial infarction or non-ischemic cardiomyopathy.
Main Results:
- 74% of patients (103/140) showed non-ischemic LGE, often in the mid-basal interventricular septum.
- 36% had combined mid-wall and junctional enhancement.
- Non-junctional LGE correlated with higher LV volumes/mass, worse LV ejection fraction, and worse global longitudinal strain.
Conclusions:
- Late gadolinium enhancement is frequent in severe AS, predominantly affecting the mid-basal interventricular septum.
- Non-junctional LGE is associated with adverse left ventricular remodeling markers.
- LGE patterns provide valuable prognostic information in severe aortic valve stenosis.
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