Extracellular Myocardial Volume in Patients With Aortic Stenosis

Everett, Russell J.; Treibel, Thomas A.; Fukui, Miho; Lee, Heesun; Rigolli, Marzia; Singh, Anvesha; Bijsterveld, Petra; Tastet, Lionel; Musa, Tarique A; Dobson, Laura E; Chin, Calvin; Captur, Gabriella; Yong, Sang; Wiesemann, Stephanie; Ferreira, Vanessa M.; Piechnik, Stefan K.; Schulz‐Menger, Jeanette; Schelbert, Erik B.; Clavel, Marie‐Annick; Newby, David E.; Myerson, Saul G.; Pibarot, P.; Lee, Sahmin; Cavalcante, João L.; Lee, Seung–Pyo; Greenwood, John P.; Moon, James; Dweck, Marc R

doi:10.1016/j.jacc.2019.11.032

Cited by 147 publications

(123 citation statements)

References 34 publications

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“…Furthermore, the reproducibility of myocardial ECV across institutions has been improving, as demonstrated in a recent large multicentre study of aortic stenosis. 17 Therefore, it is likely that these data will be generalisable to the broader Fontan population.…”

Section: Discussionmentioning

confidence: 99%

Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation

et al. 2020

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IntroductionSingle ventricle diastolic dysfunction and hepatic fibrosis are frequently observed in patients with a Fontan circulation. The relationship between adverse haemodynamics and end-organ fibrosis has not been investigated in adolescents and young adults with Fontan circulation.MethodsProspective observational study of Fontan patients who had a cardiac catheterisation. Cardiac MRI with T1 mapping was obtained to measure extracellular volume (ECV), a marker of myocardial fibrosis. Hepatic magnetic resonance elastography was performed to assess liver shear stiffness. Serum biomarkers of fibrosis including matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinases (TIMPs) were measured. Very high ECV was defined as >30% and elevated serum biomarkers as >75th percentile for each biomarker.Results25 Fontan patients (52% female) with mean age of 16.3±6.8 years were included. Mean ECV was 28%±5%. There was a significant correlation between ECV and systemic ventricular end-diastolic pressure (r=0.42, p=0.03) and between ECV and liver stiffness (r=0.45, p=0.05). Patients with elevated ECV demonstrated elevations in MMPs and TIMPs. Similarly, patients with elevated MMPs and TIMPs had greater liver stiffness compared with patients with normal levels of these biomarkers.ConclusionsIn Fontan patients, cardiac magnetic resonance evidence of myocardial fibrosis is associated with diastolic dysfunction, increased liver stiffness and elevated circulating biomarkers of fibrosis. These findings suggest the presence of a profibrotic milieu, with end-organ implications, in some patients with Fontan circulation.

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Section: Discussionmentioning

confidence: 99%

Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation

et al. 2020

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“…Thus, high liver stiffness values can be obtained without any degree of fibrosis, resulting in low positive predictive value. T1/corrected T1 (cT1) : Modified Look-Locker inversion recovery (MOLLI) T1 maps provide diagnostic information in the heart, so that increased T1 can be diagnostic of oedema (increased tissue water) or increased interstitial space [ 92 – 94 ], whilst increased extracellular volume is a powerful independent predictor of mortality in patients with severe aortic stenosis [ 95 ]. Similarly, the T1 of the water component is of diagnostic significance in the liver using MOLLI mapping or inversion recovery echo-planar imaging readouts to characterise tissue [ 28 , 68 , 96 – 98 ].…”

Section: Mpmri Methods In Clinical Practicementioning

confidence: 99%

Multiparametric MR mapping in clinical decision-making for diffuse liver disease

Thomaides-Brears¹,

Lepe

Banerjee³

et al. 2020

Abdom Radiol

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Accurate diagnosis, monitoring and treatment decisions in patients with chronic liver disease currently rely on biopsy as the diagnostic gold standard, and this has constrained early detection and management of diseases that are both varied and can be concurrent. Recent developments in multiparametric magnetic resonance imaging (mpMRI) suggest real potential to bridge the diagnostic gap between non-specific blood-based biomarkers and invasive and variable histological diagnosis. This has implications for the clinical care and treatment pathway in a number of chronic liver diseases, such as haemochromatosis, steatohepatitis and autoimmune or viral hepatitis. Here we review the relevant MRI techniques in clinical use and their limitations and describe recent potential applications in various liver diseases. We exemplify case studies that highlight how these techniques can improve clinical practice. These techniques could allow clinicians to increase their arsenals available to utilise on patients and direct appropriate treatments.

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“…Calculations were made assuming that the Cox proportional hazards regression model applies and taking into consideration a correlation of ECV% with other possible confounding covariates. On the basis of previous studies [15,17] and assuming that the power of the test should be at least 0.8, a sample size of 100 patients is required. After an adjustment for 10% patient loss or withdrawal, a total sample size of 110 patients was selected.…”

Section: Sample Size Justificationmentioning

confidence: 99%

“…Application of T1 mapping techniques, which measures native and postcontrast T1 relaxation time or extracellular volume fraction (ECV), facilitates non-invasive detection and quantification of interstitial fibrosis with high spatial resolution [11][12][13][14]. Several studies in AS patients have reported that native T1 and ECV values correlate with the degree of diffuse myocardial fibrosis and predict cardiovascular events and mortality [9,10,15]. Thus, myocardial fibrosis detection by CMR is potentially useful for improving patient risk stratification and perhaps can justify earlier aortic valve intervention, before extensive fibrosis and irreversible myocardial damage develop.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of myocardial fibrosis in severe aortic stenosis: study protocol for a prospective observational multi-center study (FIB-AS)

Balčiūnaitė

Palionis

Žurauskas

et al. 2020

BMC Cardiovasc Disord

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Background: Adverse cardiac remodeling with a myocardial fibrosis as a key pathophysiologic component may be associated to worse survival in aortic stenosis (AS) patients. Therefore, with the application of advanced cardiac imaging we aim to investigate left ventricular myocardial fibrosis in severe AS patients undergoing aortic valve replacement (AVR) and determine its impact with post-intervention clinical outcomes. Methods: In a prospective, observational, cohort study patients with severe AS scheduled either for surgical or transcatheter AVR will be recruited from two tertiary heart centers in Denmark and Lithuania. All patients will receive standard of care in accordance with the current guidelines and will undergo additional imaging testing before and after AVR: echocardiography with deformation analysis and cardiovascular magnetic resonance (CMR) with T1 parametric mapping. Those undergoing surgical AVR will also have a myocardial biopsy sampled at the time of a surgery for histological validation. Patients will be recruited over a 2-year period and followed up to 2 years to ascertain clinical outcomes. Follow-up CMR will be performed 12 months following AVR, and echocardiography with deformation analysis will be performed 3, 12, and 24 months following AVR. The study primary outcome is a composite of all-cause mortality and major adverse cardiovascular events. Discussion: Despite continuous effort of research community there is still a lack of early predictors of left ventricular decompensation in AS, which could improve patient risk stratification and guide the optimal timing for aortic valve intervention, before irreversible left ventricular damage occurs. Advanced cardiac imaging and CMR derived markers of diffuse myocardial fibrosis could be utilized for this purpose. FIB-AS study is intended to invasively and non-invasively assess diffuse myocardial fibrosis in AS patients and investigate its prognostic significance in post-interventional outcomes. The results of the study will expand the current knowledge of cardiac remodeling in AS and will bring additional data on myocardial fibrosis and its clinical implications following AVR.

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Extracellular Myocardial Volume in Patients With Aortic Stenosis

Cited by 147 publications

References 34 publications

Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation

Myocardial fibrosis, diastolic dysfunction and elevated liver stiffness in the Fontan circulation

Multiparametric MR mapping in clinical decision-making for diffuse liver disease

Prognostic value of myocardial fibrosis in severe aortic stenosis: study protocol for a prospective observational multi-center study (FIB-AS)

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