Differences in Aortic Valve and Left Ventricular Parameters Related to the Severity of Myocardial Fibrosis in Patients with Severe Aortic Valve Stenosis

Abstract

ObjectiveThis study investigated the morphological and functional characteristics of the aortic valve and the left ventricular (LV) systolic functional parameters and myocardial mass related to the severity of myocardial fibrosis (MF) in patients with severe aortic valve stenosis (AS).Materials and MethodsWe retrospectively enrolled 81 patients (48 men; mean age: 59±12 years) with severe AS who underwent transthoracic echocardiography (TTE), cardiac computed tomography (CCT), and cardiovascular magnetic resonance (CMR) within 1 month and subsequent aortic valve surgery. Degree of MF was determined on delayed contrast-enhanced CMR with visual sub-segmental analysis-based quantification and was classified into three groups (no, mild, and severe) for identifying the differences in LV function and characteristics of the aortic valve. One-way ANOVA, Chi-square test or Fisher’s exact test were used to compare variables of the three groups. Univariate multinomial logistic regression analysis was performed to determine the association between the severity of MF and variables on imaging modalities.ResultsOf 81 patients, 34 (42%) had MF (mild, n = 18; severe, n = 16). Aortic valve calcium volume score on CCT, aortic valve area, LV mass index, LV end-diastolic volume index on CMR, presence of mild aortic regurgitation (AR), transaortic mean pressure gradient, and peak velocity on TTE were significantly different among the three groups and were associated with severity of MF on a univariate multinomial logistic regression analysis. Aortic valve calcium grade was different (p = 0.008) among the three groups but not associated with severity of MF (p = 0.375).ConclusionsA multi-imaging approach shows that severe AS with MF is significantly associated with more severe calcific AS, higher LV end-diastolic volume, higher LV mass, and higher prevalence of mild AR.

Prognostic significance of vascular and valvular calcifications in low- and high-gradient aortic stenosis

“…13 The mechanisms underlying the association of VAC with post-TAVI outcomes may be linked to an increased rate of periprocedural complications, device failure, pacemaker implantation, or paravalvular leak. 14,15 AS severity, and thus VAC, is also correlated with myocardial fibrosis, 16 which is mostly irreversible and influences post-operative mortality 17 and heart failure. 18 This may explain that VAC continued to have a prognostic significance over the long run, i.e.…”

Role of Cardiac Computed Tomography in the Diagnosis of Left Ventricular Myocardial Diseases

“…Cardiac CT is an important imaging modality in severe AS patients who are indicated for surgical valve replacement or transcatheter aortic valve replacement, because it provides detailed anatomic information about the aortic valve, coronary artery, ascending thoracic aorta, and LV 83). Recently, Song et al84) showed that aortic valve calcium volume score on cardiac CT was associated with severity of myocardial fibrosis in severe AS patients. Bandula et al20) showed that there was a significant correlation between both equilibrium cardiac CT - and equilibrium CMR imaging-derived ECV and percentage of histologic fibrosis (r = 0.71, p < 0.001 and r = 0.84, p < 0.0001, respectively).…”