Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis

Abstract

In patients with severe aortic valve stenosis, the amount of myocardial fibrosis appears to have significant effect on clinical status and long-term survival after aortic valve replacement. From these results, we believe that new strategies for the earlier detection of myocardial fibrosis are needed to achieve a better prognostic outcome.

Severe aortic stenosis with preserved ejection fraction and evidence of impairment in structure, myocardial strain and ventricular function: A new contribution to clinical decision making

“…Evi- dence shows that changes in structure, particularly fibrosis, are an early finding in the progression of AS [47] and determine aspects of systolic, as well as diastolic function [48], which entail prognostic value and affect long-term survival following aortic valve replacement [49]. This adverse progression is related to myocardial failure which is probably an evolving process, as described by Meerson [50], and of which many aspects remain unknown.…”

Accurate Assessment of Aortic Stenosis

“…Recent studies have also suggested that a careful investigation of the myocardium, particularly the extent of myocardial fibrosis, may be beneficial toward assessing the severity of AS progression. [103][104][105] In particular, an investigation of the extent and type of myocardial fibrosis may be beneficial toward assessing the potential for favorable ventricular remodeling after valve replacement. Such an assessment may be conducted noninvasively by the use of MRI or echocardiography or by measuring the levels of brain natriuretic peptide.…”

“…Studie z nedávné doby naznačily, že důkladné vyšetření myokardu, zvláště rozsahu fi brózy myokardu, může napomoci při stanovení progrese závažnosti AS. [103][104][105] Zvláště vyšetření rozsahu a typu fi brózy myokardu může být přínosné pro stanovení možné příznivé remodelace LK po náhradě chlopně. Toto vyšetření lze provést neinvazivně pomocí MR nebo echokardiografi cky, příp.…”

The Future of Cardiovascular Imaging

“…The extent of myocardial fibrosis using CMR techniques such as LGE and T1 mapping, particularly measures of extracellular volume), provides prognostic value and can be used to guide timing of intervention. [38][39][40][41][42][43] Although EF may be normal despite these structural changes, sensitive functional measures of LV contractility such as strain and strain rate are now able to provide incremental prognostic information and guide timing of intervention before major morbidity and mortality occurs. [44][45][46] The focus in regurgitant valvular diseases, such as mitral regurgitation, has mostly centered on regurgitant volume, the functional regurgitant orifice size, and the impact of the volume overload on chamber geometry and function in conjunction with functional capacity.…”

“…El grado de fibrosis miocárdica utilizando técnicas de RMC como LGE y mapeo de T1, particularmente mediciones de volumen extracelular, brinda valor pronóstico y puede usarse para guiar el ritmo de intervención. [38][39][40][41][42][43] Si bien la FE puede ser normal a pesar de estos cambios estructurales, las mediciones funcionales sensibles de la contractilidad del VI como la deformación y la tasa de deformación son ahora capaces de proveer información pronóstica gradual y orientar el momento de intervención antes de que ocurra mayor morbilidad y mortalidad. [44][45][46] Figura 2.…”