Prevalence and prognostic significance of left ventricular myocardial late gadolinium enhancement in severe aortic stenosis

Abstract Myocardial fibrosis, as detected by late gadolinium enhancement (LGE) magnetic resonance imaging (MRI), is related to mortality after aortic valve replacement (AVR). This study aimed to determine whether LGEMRI predicts improvement in global longitudinal strain (GLS) after AVR in patients with severe aortic stenosis (AS). Twenty-nine patients with severe AS who were scheduled to undergo AVR were enrolled. Two-dimensional echocardiography and contrast-enhanced MRI were performed before AVR. GLS and LGEcore (g: > 5 SD of normal area), LGEgray (g: 2–5 SD), and LGEcore+gray (g) were measured. One year after AVR, GLS were examined by echocardiography to assess improvement in LV function. Preoperatively, GLS correlated with LGEcore (g) (r2 = 0.14, p < 0.05), LGEgray (g) (r2 = 0.32, p < 0.01) and LGEcore+gray (g) (r2 = 0.36, p < 0.01). LGEcore was significantly lower in patients with improved GLS after AVR (GLS1year ≥ −19.9%) compared to those with no improvement (1.34 g vs. 4.70 g, p < 0.01). LGE predicts improvement in LV systolic function after AVR.

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332 Clinical and prognostic significance of junctional late gadolinium enhancement in patients with non-ischaemic cardiomyopathy

European Heart Journal Supplements ◽

10.1093/eurheartj/suab142.011 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Laura De Michieli ◽

Manuel De Lazzari ◽

Giorgio Porcelli ◽

Alberto Cipriani ◽

Matteo Dalla Libera ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Hypertension ◽

Late Gadolinium Enhancement ◽

Prognostic Significance ◽

Left Ventricular ◽

Control Group ◽

Significant Determinant ◽

Gadolinium Enhancement ◽

Hemodynamic Profile

Abstract Aims Pulmonary hypertension (PH) carries a poor prognosis in patients with non-ischaemic dilated cardiomyopathy (NIDC). Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) evaluation can identify myocardial abnormalities. In particular, junctional LGE is already an established marker of adverse right ventricular (RV) remodelling in patients with pre-capillary PH. This study sought to assess the prevalence of junctional LGE by CMR in NIDC, its relationship with hemodynamic parameters and, moreover, its prognostic significance. Methods and results Patients with NIDC who underwent right heart catheterization (RHC) and CMR within 3 months in a tertiary hospital were enrolled. Patients with acute heart failure were excluded. Among others, RV and left ventricular (LV) volumes, junctional LGE at CMR, pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP) at RHC were tabulated. Pulmonary hypertension was defined accordingly to current Guidelines (median PAP at RHC ≥ 25 mmHg). The primary endpoint consisted of heart failure (HF) hospitalization during follow-up. A total of 188 patients [median age 49 (SD 15), 71% males] were evaluated. At morpho-functional CMR evaluation, most subjects (76%) had important systolic dysfunction (LV EF ≤ 35%). Junctional LGE was observed in 83 (44%) patients. Among patients with junctional LGE, 21 had LGE confined only to the junctional region, while 61 had also mid-wall interventricular septal stria and 21 a mid-wall stria in the lateral free LV wall. Patients with junctional LGE had lower RV EF (49% vs. 56%, P < 0.001) and LV EF (27% vs. 30%, P = 0.012) when compared to those without junctional LGE although no differences in LV and RV dimensions were found. RHC showed PH in 83 patients (44%). Patients with junctional LGE showed a worse hemodynamic profile in terms of PH (55% vs. 36%; P = 0.011) and increase in PCWP (PCWP > 15 mmHg in 60% vs. 42%; P = 0.015) compared to subjects without junctional LGE. Among 79 patients with PH and PCWP > 15 mmHg, 75 (95%) had a combined post capillary and pre-capillary PH (diastolic pressure gradient ≥7 mmHg). Univariate analysis showed that junctional LGE was associated with a worse hemodynamic profile; on multivariable model, RV EF was significantly associated with the presence of junctional LGE (OR: 0.91; 95% CI: 0.87–0.96, P < 0.001). During a median follow-up of 58 months, 33 patients (18%) died or underwent heart transplantation/ventricular assist device implantation, 17% in the junctional LGE group vs. 18% among those without junctional LGE. Thirty-eight patients (20%) had at least one episode of HF, 22 among junctional LGE group and 16 in control group (27% vs. 15%, P = 0.056). When adjusted for age, junctional LGE resulted a significant determinant of HF hospitalization (OR: 2.13, 95% CI: 1.02–4.44, P = 0.044). Conclusions Junctional LGE is detectable in almost half of NIDC patients and it is related to a worse haemodynamic profile, characterized by PH and elevated PCWP. Moreover, after adjustment for age, it was a significant determinant of HF hospitalization during follow-up in our population. Junctional LGE can therefore represent a useful prognostic tool, as marker of adverse ventricular remodelling likely related to ventricular interdependence.

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Late Gadolinium Enhancement in Cardiac MRI in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Is Related to Attenuated Improvement of Left Ventricular Geometry and Filling Pressure after Aortic Valve Replacement

Korean Circulation Journal ◽

10.4070/kcj.2014.44.5.312 ◽

2014 ◽

Vol 44 (5) ◽

pp. 312 ◽

Cited By ~ 8

Author(s):

Junbeom Park ◽

Hyuk-Jae Chang ◽

Jung-Ho Choi ◽

Pil-Sung Yang ◽

Sang-Eun Lee ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Systolic Function ◽

Severe Aortic Stenosis ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Filling Pressure ◽

Left Ventricular Geometry ◽

Gadolinium Enhancement ◽

Ventricular Systolic Function ◽

Ventricular Geometry

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Prognostic Significance of Valvuloarterial Impedance and Left Ventricular Longitudinal Function in Asymptomatic Severe Aortic Stenosis Involving Three-Cuspid Valves

The American Journal of Cardiology ◽

10.1016/j.amjcard.2011.06.070 ◽

2011 ◽

Vol 108 (10) ◽

pp. 1463-1469 ◽

Cited By ~ 38

Author(s):

Concetta Zito ◽

Josephal Salvia ◽

Maurizio Cusmà-Piccione ◽

Francesco Antonini-Canterin ◽

Salvatore Lentini ◽

...

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Prognostic Significance ◽

Left Ventricular ◽

Longitudinal Function

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Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis

10.20944/preprints201812.0338.v1 ◽

2018 ◽

Author(s):

Lucia Agoston-Coldea ◽

Kunal Bheecarry ◽

Carmen Cionca ◽

Cristian Petra ◽

Lelia Strimbu ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Aortic Stenosis ◽

Predictive Value ◽

Longitudinal Axis ◽

Left Ventricular ◽

Hazard Ratio ◽

Gadolinium Enhancement ◽

Cox Regression Analysis ◽

Incremental Value ◽

Cmr Imaging

To analyze the predictive ability and incremental value of left ventricular longitudinal axis strain (LAS) and late gadolinium enhancement (LGE) using standard cardiovascular magnetic resonance (CMR) imaging for the diagnosis and prognosis of severe aortic stenosis (AS) in patients with an indication for aortic valve replacement. We conducted a prospective study on 128 patients with severe AS and 52 volunteers. The evaluation protocol included standard biochemistry tests, novel biomarkers of myocardial fibrosis, 12-lead electrocardiograms and 24-hour Holter, the 6-minute walk test and extensive echocardiographic and CMR imaging studies. Outcomes were defined as the composite of major cardiovascular events (MACEs). Among AS patients, most (n = 17, 77.2%) of those who exhibited LGE at CMR imaging had MACEs during follow-up. Kaplan-Meier curves for event-free survival showed a significantly higher rate of MACEs in patients with LGE (p < 0.01) and decreased LAS (p < 0.001). In Cox regression analysis, only reduced LAS [hazard ratio 1.33, 95%CI (1.01 to 1.74), p < 0.01] and the presence of LGE [hazard ratio 11.3, 95%CI (1.82 to 70.0), p < 0.01] were independent predictors for MACEs. The predictive value increased if both LGE and reduced LAS were added to LVEF. None of the biomarkers of increased collagen turnover exhibited any predictive value for MACEs. LAS by CMR is an independent predictor of outcomes in patients with AS and provides incremental value beyond the assessment of LVEF and the presence of LGE.

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Prevalence and prognostic value of left ventricular late gadolinium enhancement in patients with idiopathic outflow tract ventricular arrhythmias

European Heart Journal ◽

10.1093/ehjci/ehaa946.0257 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Nucifora ◽

D Muser ◽

S Castro ◽

R Casado Arroyo ◽

D Benhayon ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Ventricular Arrhythmias ◽

Incidental Finding ◽

Large Population ◽

Prognostic Significance ◽

Right Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Major Adverse Cardiovascular Events ◽

Gadolinium Enhancement

Abstract Background Patients with idiopathic outflow tract ventricular arrhythmias (OTVAs) and structurally normal heart by ECG and echocardiogram often undergo cardiac magnetic resonance (CMR) study to evaluate for presence of concealed myocardial abnormalities with late gadolinium enhancement (LGE). However, the clinical impact of incidental LGE finding in the left ventricle (LV) in patients with idiopathic OT-VAs is unclear. Accordingly, the aim of the present study was to investigate the prevalence, characteristics and prognostic significance of isolated LV LGE in a large population of patients with OTVA undergoing CMR. Methods A total of 364 consecutive patients (43±16 years, 53% male) with OTVA and negative routine diagnostic work-up were included. All patients underwent a CMR study with LGE imaging for detection of scar/replacement fibrosis. Presence of LGE was correlated with long term major adverse cardiovascular events including sudden cardiac death (SCD), resuscitated cardiac arrest and nonfatal documented sustained ventricular tachycardia. Results Isolated LGE in the LV was identified in 15 patients (4%), typically involving the inferolateral wall (11 cases, 73%) and having a median extension of 3 (2–5)% of the LV mass. All cases showed a midmyocardial/subepicardial distribution consistent with a possible prior myocarditis. Patients with incidental finding of LV-LGE were older (55±13 years vs. 42±16 years; p<0.01) and were more frequently males (80% vs. 51%; p=0.03). After a median follow-up of 69 (47–98) months, none of the patients in the LV-LGE group and 1 patient (0.3%) in the non-LGE group (p=1.0) experienced the composite end-point which consisted in an episode of sustained VT with hypotension and dizziness. The patient subsequently underwent effective radiofrequency ablation of the VT from the right ventricular outflow tract. Conclusion In this large CMR study, isolated LV scar was found in 4% of patients with idiopathic OT-VAs, was small in size with distribution consistent with prior myocarditis. The LGE abnormality did not portend a negative prognosis. Funding Acknowledgement Type of funding source: None

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Incremental Predictive Value of Longitudinal Axis Strain and Late Gadolinium Enhancement Using Standard CMR Imaging in Patients with Aortic Stenosis

Journal of Clinical Medicine ◽

10.3390/jcm8020165 ◽

2019 ◽

Vol 8 (2) ◽

pp. 165 ◽

Cited By ~ 4

Author(s):

Lucia Agoston-Coldea ◽

Kunal Bheecarry ◽

Carmen Cionca ◽

Cristian Petra ◽

Lelia Strimbu ◽

...

Keyword(s):

Late Gadolinium Enhancement ◽

Aortic Stenosis ◽

Predictive Value ◽

Longitudinal Axis ◽

Left Ventricular ◽

Hazard Ratio ◽

Left Ventricular Ejection ◽

Gadolinium Enhancement ◽

Incremental Value ◽

Cmr Imaging

To analyse the predictive ability and incremental value of left ventricular longitudinal axis strain (LAS) and late gadolinium enhancement (LGE) using standard cardiovascular magnetic resonance (CMR) imaging for the diagnosis and prognosis of severe aortic stenosis (AS) in patients with an indication for aortic valve replacement. We conducted a prospective study on 52 patients with severe AS and 52 volunteers. The evaluation protocol included standard biochemistry tests, novel biomarkers of myocardial fibrosis, 12-lead electrocardiograms and 24-hour Holter, the 6-minute walk test and extensive echocardiographic and CMR imaging studies. Outcomes were defined as the composite of major cardiovascular events (MACEs). Among AS patients, most (n = 17, 77.2%) of those who exhibited LGE at CMR imaging had MACEs during follow-up. Kaplan–Meier curves for event-free survival showed a significantly higher rate of MACEs in patients with LGE (p < 0.01) and decreased LAS (p < 0.001). In Cox regression analysis, only reduced LAS (hazard ratio 1.33, 95% CI (1.01 to 1.74), p < 0.01) and the presence of LGE (hazard ratio 11.3, 95% CI (1.82 to 70.0), p < 0.01) were independent predictors for MACEs. The predictive value increased if both LGE and reduced LAS were added to left ventricular ejection fraction (LVEF). None of the biomarkers of increased collagen turnover exhibited any predictive value for MACEs. LAS by CMR is an independent predictor of outcomes in patients with AS and provides incremental value beyond the assessment of LVEF and the presence of LGE.

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