Midwall Fibrosis and 5-Year Outcome in Moderate and Severe Aortic Stenosis

Vassiliou, Vassilios; Perperoglou, Aris; Raphael, Claire E.; Joshi, Sanjiv; Malley, Tamir; Everett, Russell J.; Halliday, Brian P; Pennell, Dudley J.; Dweck, Marc R; Prasad, Sanjay K.

doi:10.1016/j.jacc.2017.01.034

Cited by 50 publications

(38 citation statements)

References 5 publications

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“…Histological and imaging studies have suggested that focal myocardial fibrosis is a key driver in the transition from hypertrophy to heart failure. 6 – 10 Myocardial replacement fibrosis (scar) can be detected by cardiovascular magnetic resonance (CMR) with the late gadolinium enhancement (LGE) technique. From single-center studies, focal fibrosis has been associated with increased levels of myocardial injury, diastolic and systolic dysfunction, electrocardiographic changes, and adverse clinical outcomes.…”

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confidence: 99%

“…From single-center studies, focal fibrosis has been associated with increased levels of myocardial injury, diastolic and systolic dysfunction, electrocardiographic changes, and adverse clinical outcomes. 7 – 10 Focal scar by LGE is irreversible at 9 and 12 months after SAVR. 5 , 11 CMR-detected myocardial fibrosis therefore appears to be a useful and objective biomarker of LV decompensation in AS.…”

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Myocardial Scar and Mortality in Severe Aortic Stenosis

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Myocardial Scar and Mortality in Severe Aortic Stenosis

et al. 2018

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“…A recent study has demonstrated that the incremental value of detecting focal fibrosis using LGE alongside conventional parameter (LVEF), in predicting 5-year mortality in patients with aortic stenosis (61). Furthermore, Halliday et al have reported recently the value of mid-wall focal fibrosis as detected by LGE in predicting SCD in patients with dilated cardiomyopathy and LVEF >40% (62).…”

Section: Myocardial Fibrosismentioning

confidence: 99%

Myocardial Architecture, Mechanics, and Fibrosis in Congenital Heart Disease

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et al. 2017

Front. Cardiovasc. Med.

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Congenital heart disease (CHD) is the most common category of birth defect, affecting 1% of the population and requiring cardiovascular surgery in the first months of life in many patients. Due to advances in congenital cardiovascular surgery and patient management, most children with CHD now survive into adulthood. However, residual and postoperative defects are common resulting in abnormal hemodynamics, which may interact further with scar formation related to surgical procedures. Cardiovascular magnetic resonance (CMR) has become an important diagnostic imaging modality in the long-term management of CHD patients. It is the gold standard technique to assess ventricular volumes and systolic function. Besides this, advanced CMR techniques allow the acquisition of more detailed information about myocardial architecture, ventricular mechanics, and fibrosis. The left ventricle (LV) and right ventricle have unique myocardial architecture that underpins their mechanics; however, this becomes disorganized under conditions of volume and pressure overload. CMR diffusion tensor imaging is able to interrogate non-invasively the principal alignments of microstructures in the left ventricular wall. Myocardial tissue tagging (displacement encoding using stimulated echoes) and feature tracking are CMR techniques that can be used to examine the deformation and strain of the myocardium in CHD, whereas 3D feature tracking can assess the twisting motion of the LV chamber. Late gadolinium enhancement imaging and more recently T1 mapping can help in detecting fibrotic myocardial changes and evolve our understanding of the pathophysiology of CHD patients. This review not only gives an overview about available or emerging CMR techniques for assessing myocardial mechanics and fibrosis but it also describes their clinical value and how they can be used to detect abnormalities in myocardial architecture and mechanics in CHD patients.

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“…These included standard cine views to evaluate left ventricular function, contrast-enhanced MR angiography acquired in diastole, late gadolinium enhancement for assessment of midwall fibrosis or infarction (8,9) and a new interleaved T1-weighted sequence ('CATCH') (10). The pre-contrast CATCH sequence facilitates acquisition of a dark-blood T1-weighted image in one heartbeat followed by an anatomical bright-blood reference in the next; post-reconstruction, a hyper-intense signal has been shown to correspond to thrombus or potential intra-plaque hemorrhage (10).…”

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confidence: 99%