Late gadolinium enhancement as a potential marker of increased perioperative risk in aortic valve replacement

Quarto, Cesare; Dweck, Marc R; Murigu, Timothy; Joshi, Sanjiv; Melina, Giovanni; Angeloni, Emiliano; Prasad, Sanjay; Pepper, John

doi:10.1093/icvts/ivs098

Cited by 31 publications

(16 citation statements)

References 12 publications

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“…It is noteworthy that RV dysfunction post operatively is an adverse prognostic marker(5) and in a small study, patients without LV LGE had no 30-day MACCE events and no deaths up to 2 years following SAVR (19). In our patients without baseline hyperenhancement, SAVR was not associated with a change in RV ejection fraction at 6 months.…”

Section: Discussionmentioning

confidence: 48%

Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study

Musa

Uddin

Fairbairn

et al. 2016

International Journal of Cardiology

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Objective: The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR.Methods: A 1.5T CMR scan was performed preoperatively and 6 months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8 years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres.Results: TAVI patients were older (80.4±6.7 vs. 72.8±7.2 years, p<0.05) with a higher STS score (2.13 ± 0.73 vs. 5.54 ± 3.41%, p< 0.001). At 6 months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m 2 , p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6 months.Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6 months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3 year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108-1.666, p=0.003). Conclusions: SAVR results in a deterioration

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Section: Discussionmentioning

confidence: 48%

Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study

Musa

Uddin

Fairbairn

et al. 2016

International Journal of Cardiology

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“…1 Calcification and inflammation are thought to play key pathophysiological roles. Indeed, the amount of established calcium in the valve correlates with disease severity and predicts future adverse cardiovascular events.…”

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confidence: 99%

18F-Sodium Fluoride Uptake Is a Marker of Active Calcification and Disease Progression in Patients With Aortic Stenosis

Dweck¹,

Jenkins²,

Vesey

et al. 2014

Circ: Cardiovascular Imaging

214

126

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Background— 18F-Sodium fluoride (18F-NaF) and 18F-fluorodeoxyglucose (18F-FDG) are promising novel biomarkers of disease activity in aortic stenosis. We compared 18F-NaF and 18F-FDG uptake with histological characterization of the aortic valve and assessed whether they predicted disease progression. Methods and Results— Thirty patients with aortic stenosis underwent combined positron emission and computed tomography using 18F-NaF and 18F-FDG radiotracers. In 12 patients undergoing aortic valve replacement surgery (10 for each tracer), radiotracer uptake (mean tissue/background ratio) was compared with CD68 (inflammation), alkaline phosphatase, and osteocalcin (calcification) immunohistochemistry of the excised valve. In 18 patients (6 aortic sclerosis, 5 mild, and 7 moderate), aortic valve computed tomography calcium scoring was performed at baseline and after 1 year. Aortic valve 18F-NaF uptake correlated with both alkaline phosphatase ( r =0.65; P =0.04) and osteocalcin ( r =0.68; P =0.03) immunohistochemistry. There was no significant correlation between 18F-FDG uptake and CD68 staining ( r =−0.43; P =0.22). After 1 year, aortic valve calcification increased from 314 (193–540) to 365 (207–934) AU ( P <0.01). Baseline 18F-NaF uptake correlated closely with the change in calcium score ( r =0.66; P <0.01), and this improved further ( r =0.75; P <0.01) when 18F-NaF uptake overlying computed tomography–defined macrocalcification was excluded. No significant correlation was noted between valvular 18F-FDG uptake and change in calcium score ( r =−0.11; P =0.66). Conclusions— 18F-NaF uptake identifies active tissue calcification and predicts disease progression in patients with calcific aortic stenosis. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01358513.

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“…Stiffness of MI area and the rest of the myocardium is also studied by MRI elastography where the MI area is discriminated from the rest of the myocardium by the difference between the motion stiffness of those areas (MI, 4.6 ± 0.7 kPA; healthy, 3.0 ± 0.6 kPA) [73,76]. Moreover, cMRI has an ability to determine with great accuracy mitral valve [77] and aortic valve [78] malfunctions, which often occur as MI develops and therefore imaging the function of mitral and aortic valves might give additional information about the heart's condition [77].…”

Section: Other Mri Techniquesmentioning

confidence: 99%

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

Ylä-Herttuala

Saraste

Knuuti

et al. 2019

Curr Cardiovasc Imaging Rep

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Purpose of Review Cardiovascular diseases are the leading cause of deaths worldwide. Many complex cellular and molecular pathways lead to myocardial remodeling after ischemic insults. Anatomy, function, and viability of the myocardium can be assessed by modern medical imaging techniques by both visualizing and quantifying damages. Novel imaging techniques aim for a precise and accurate visualization of the myocardium and for the detection of alternations at the molecular level. Recent Findings Magnetic resonance imaging assesses anatomy, function, and tissue characterization of the myocardium noninvasively with high spatial resolution, sensitivity, and specificity. Using hyperpolarized magnetic resonance imaging, molecular and metabolic conditions can be assessed non-invasively. Single photon-emission tomography and positron-emission tomography are the most sensitive techniques to detect biological processes in the myocardium. Cardiac perfusion, metabolism, and viability are the most common clinical targets. In addition, molecular-targeted imaging of biological processes involved in heart failure, such as myocardial innervation, inflammation, and extracellular matrix remodeling, is feasible. Summary Novel imaging techniques can provide a precise and accurate visualization of the myocardium and for the detection of alternations at molecular level.

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Late gadolinium enhancement as a potential marker of increased perioperative risk in aortic valve replacement

Cited by 31 publications

References 12 publications

Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study

Right ventricular function following surgical aortic valve replacement and transcatheter aortic valve implantation: A cardiovascular MR study

18F-Sodium Fluoride Uptake Is a Marker of Active Calcification and Disease Progression in Patients With Aortic Stenosis

Molecular Imaging to Monitor Left Ventricular Remodeling in Heart Failure

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