Prognostic value of cardiac magnetic resonance in patients with aortic stenosis: A systematic review and meta-analysis

Zhang, Chuan; Liu, Jie; Shu, Qin

doi:10.1371/journal.pone.0263378

Cited by 7 publications

(6 citation statements)

References 55 publications

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“…In addition, we did not examine changes in cardiac structure following TAVI. While evidence suggests that persistent fibrosis following TAVI may be central to future HF, 49 further studies in this cohort and others are required to understand how baseline pre‐TAVI metabolism and changes following TAVI correspond to the capacity for reverse remodeling in the heart (and other organs). The cohorts studied underwent TAVI ≥5 years ago, which may limit generalizability to contemporary cohorts.…”

Section: Discussionmentioning

confidence: 97%

Metabolic Signatures of Cardiac Dysfunction, Multimorbidity, and Post–Transcatheter Aortic Valve Implantation Death

Perry

Zhao

Murthy

et al. 2023

JAHA

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Background Studies in mice and small patient subsets implicate metabolic dysfunction in cardiac remodeling in aortic stenosis, but no large comprehensive studies of human metabolism in aortic stenosis with long‐term follow‐up and characterization currently exist. Methods and Results Within a multicenter prospective cohort study, we used principal components analysis to summarize 12 echocardiographic measures of left ventricular structure and function pre–transcatheter aortic valve implantation in 519 subjects (derivation). We used least absolute shrinkage and selection operator regression across 221 metabolites to define metabolic signatures for each structural pattern and measured their relation to death and multimorbidity in the original cohort and up to 2 validation cohorts (N=543 for overall validation). In the derivation cohort (519 individuals; median age, 84 years, 45% women, 95% White individuals), we identified 3 axes of left ventricular remodeling, broadly specifying systolic function, diastolic function, and chamber volumes. Metabolite signatures of each axis specified both known and novel pathways in hypertrophy and cardiac dysfunction. Over a median of 3.1 years (205 deaths), a metabolite score for diastolic function was independently associated with post–transcatheter aortic valve implantation death (adjusted hazard ratio per 1 SD increase in score, 1.54 [95% CI, 1.25–1.90]; P <0.001), with similar effects in each validation cohort. This metabolite score of diastolic function was simultaneously associated with measures of multimorbidity, suggesting a metabolic link between cardiac and noncardiac state in aortic stenosis. Conclusions Metabolite profiles of cardiac structure identify individuals at high risk for death following transcatheter aortic valve implantation and concurrent multimorbidity. These results call for efforts to address potentially reversible metabolic biology associated with risk to optimize post–transcatheter aortic valve implantation recovery, rehabilitation, and survival.

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Section: Discussionmentioning

confidence: 97%

Metabolic Signatures of Cardiac Dysfunction, Multimorbidity, and Post–Transcatheter Aortic Valve Implantation Death

Perry

Zhao

Murthy

et al. 2023

JAHA

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“…Additionally, CMR's ability to detect myocardial fibrosis contributes to prognostic value in AS patients, optimizing the timing of AVR for improved outcomes. 84 …”

Section: Diagnosis Of Amyloidosis In the Setting Of Aortic Stenosismentioning

confidence: 99%

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Jaiswal,

Agrawal,

Khulbe

et al. 2023

European Heart Journal Open

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Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded proteins infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin-cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4 to 16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic work-up for cardiac amyloidosis in patients with aortic stenosis is based on a multiparametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, technetium labeled cardiac scintigraphy like 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylenediphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.

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“…Regarding AS, CMR can be used to assess myocardial fibrosis and to identify risk factors 98,99. A recent meta-analysis100 demonstrated that CMR helps in risk stratification of AS and may help optimize the timing of aortic valve replacement. The assessment of the aortic valve and aortic root in CMR is helpful in TAVR procedures, especially in patients who cannot be assessed by CT imaging 101…”

Section: Imaging In Structural Heart Diseasementioning

confidence: 99%

The Chinese Experience of Imaging in Cardiac Intervention

Liu

Yang

Chen

2022

Journal of Thoracic Imaging

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Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.

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Prognostic value of cardiac magnetic resonance in patients with aortic stenosis: A systematic review and meta-analysis

Cited by 7 publications

References 55 publications

Metabolic Signatures of Cardiac Dysfunction, Multimorbidity, and Post–Transcatheter Aortic Valve Implantation Death

Metabolic Signatures of Cardiac Dysfunction, Multimorbidity, and Post–Transcatheter Aortic Valve Implantation Death

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

The Chinese Experience of Imaging in Cardiac Intervention

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