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Interstitial Myocardial Fibrosis Analysis by Histology and Cardiac Magnetic Resonance in Severe Aortic Valve Disease

Juliana Hiromi Silva Matsumoto Bello1, Lea M M F Demarchi2, Rafael Almeida Fonseca1

  • 1Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil.

Arquivos Brasileiros De Cardiologia
|May 19, 2026
PubMed
Abstract

Insights

Cardiac magnetic resonance (CMR) detects myocardial fibrosis (MF) in aortic valve disease. Late gadolinium enhancement (LGE) and extracellular volume (ECV) show moderate correlation with biopsy-confirmed collagen volume fraction (CVF).

Area of Science:

  • Cardiovascular Imaging
  • Cardiac Pathology
  • Biomarker Discovery

Background:

  • Aortic valve disease is associated with myocardial fibrosis (MF).
  • Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) assesses regional fibrosis.
  • Interstitial fibrosis, estimated by extracellular volume (ECV) via T1 mapping, is not detected by LGE.

Purpose of the Study:

  • To compare myocardial fibrosis (MF) measured by collagen volume fraction (CVF) in myocardial biopsy with LGE and ECV.
  • To evaluate the diagnostic performance and agreement of LGE and ECV against CVF in severe aortic valve disease.

Main Methods:

  • 108 patients with severe aortic valve disease undergoing aortic valve replacement provided myocardial biopsy and preoperative CMR.
  • Late gadolinium enhancement (LGE) and extracellular volume (ECV) were quantified from CMR.
  • LGE and ECV were compared with biopsy-derived collagen volume fraction (CVF) using correlation and agreement analyses.

Main Results:

  • Increased CVF was prevalent (96%), while LGE (44%) and ECV (33.3%) were less frequent.
  • Moderate correlations were observed between LGE and CVF (r=0.44) and between ECV and CVF (r=0.36).
  • LGE showed higher sensitivity (64.8%) and accuracy (71%) than ECV (40.7% sensitivity, 57% accuracy) in detecting MF.

Conclusions:

  • Cardiac magnetic resonance (CMR) can detect myocardial fibrosis (MF) in severe aortic valve disease, as confirmed by biopsy.
  • Late gadolinium enhancement (LGE) and extracellular volume (ECV) demonstrate moderate correlation with collagen volume fraction (CVF).
  • Combined LGE and ECV analysis may offer complementary insights into MF, warranting further investigation into their prognostic value.

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