scholarly journals Imaging of Myocardial Fibrosis and Its Functional Correlates in Aortic Stenosis: A Review and Clinical Potential

Cardiology ◽  
2018 ◽  
Vol 141 (3) ◽  
pp. 141-149 ◽  
Author(s):  
Asim Katbeh ◽  
Tomas Ondrus ◽  
Emanuele Barbato ◽  
Maurizio Galderisi ◽  
Bruno Trimarco ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Severe Aortic Stenosis ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Diagnostic Challenge ◽  
Functional Changes ◽  
Ventricular Mechanics ◽  
Diagnostic Potential

Patients with severe aortic stenosis (AS) show progressive fibrotic changes in the myocardium, which may impair cardiac function and patient outcomes even after successful aortic valve replacement. Detection of patients who need an early operation remains a diagnostic challenge as myocardial functional changes may be subtle. In recent years, speckle tracking echocardiography (STE) and cardiac magnetic resonance mapping have been shown to provide complementary information for the assessment of left ventricular mechanics and identification of subtle damage by focal or diffuse myocardial fibrosis, respectively. Little is known, however, about how focal and diffuse myocardial fibrosis occurring in severe AS are related to measurable functional changes by echocardiography and to which extent both parameters have prognostic and diagnostic value. The aims of this review are to discuss the occurrence of focal and diffuse myocardial fibrosis in patients with severe AS and to explore their relation with myocardial function, determined by STE, as well as the prognostic and diagnostic potential of both parameters.

scholarly journals A model based on clinical parameters to identify myocardial late gadolinium enhancement by magnetic resonance in patients with aortic stenosis: An observational study

2020 ◽  
Vol 9 ◽  
pp. 204800402092240
Author(s):  
Mariya Kuk ◽  
Simon Newsome ◽  
Francisco Alpendurada ◽  
Marc Dweck ◽  
Dudley J Pennell ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Stenosis ◽  
Risk Stratification ◽  
Myocardial Fibrosis ◽  
Surgical Intervention ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Study Patient ◽  
Ventricular Ejection Fraction

Objective With increasing age, the prevalence of aortic stenosis grows exponentially, increasing left heart pressures and potentially leading to myocardial hypertrophy, myocardial fibrosis and adverse outcomes. To identify patients who are at greatest risk, an outpatient model for risk stratification would be of value to better direct patient imaging, frequency of monitoring and expeditious management of aortic stenosis with possible earlier surgical intervention. In this study, a relatively simple model is proposed to identify myocardial fibrosis in patients with a diagnosis of moderate or severe aortic stenosis. Design Patients with moderate to severe aortic stenosis were enrolled into the study; patient characteristics, blood work, medications as well as transthoracic echocardiography and cardiovascular magnetic resonance were used to determine potential identifiers of myocardial fibrosis. Setting The Royal Brompton Hospital, London, UK Participants One hundred and thirteen patients in derivation cohort and 26 patients in validation cohort. Main outcome measures Identification of myocardial fibrosis. Results Three blood biomarkers (serum platelets, serum urea, N-terminal pro-B-type natriuretic peptide) and left ventricular ejection fraction were shown to be capable of identifying myocardial fibrosis. The model was validated in a separate cohort of 26 patients. Conclusions Although further external validation of the model is necessary prior to its use in clinical practice, the proposed clinical model may direct patient care with respect to earlier magnetic resonance imagining, frequency of monitoring and may help in risk stratification for surgical intervention for myocardial fibrosis in patients with aortic stenosis.

P5575Acute left ventricular mechanics changes after TAVR: the afterload concept revisited

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Procopi ◽  
N Procopi ◽  
J P Collet ◽  
O Barthelemy ◽  
P Leprince ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Abrupt Decrease ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Ventricular Mechanics ◽  
Lv Systolic Function

Abstract Background Recent studies have emphasized the prognostic value of mild left ventricular ejection fraction (LVEF) impairment in severe aortic stenosis. However, despite adaptive mechanisms to pressure overload, subtle impaired systolic function could be worsened by increased afterload and partly reversible immediately after its correction. Objectives The aim was to evaluate the short terms effects of transcatheter aortic valve replacement (TAVR) on LV systolic function assessed by global longitudinal strain (GLS). We hypothesized that abrupt decrease of LV afterload after TAVR could lead to immediate improvement of LV systolic function. Methods Patients referred to our Department for TAVR were included from January 2018 to July 2018 in this observational prospective single center study. Transthoracic echocardiography (TTE) was performed immediately before and 1–5 days after TAVR by the same operator and reviewed in a blind fashion. Results 35 symptomatic patients with severe aortic stenosis referred for TAVR (age 84±5 y, 18 male, NYHA 2–3, orifice area 0.7±0.2 cm2, LVEF 66±13%, GLS −15.1±4.7%) were included. Only 9/35 (26%) had a LVEF ≤60%. Overall, no significant change in LVEF (65±14%; p=0.55) or GLS (−16.1±4.8%; p=0.11) occurred immediately after TAVR despite a dramatic decrease in transoartic mean pressure gradient (44±15 mm Hg versus 6±3 mmHg; p<0.0001). However in the subgroup of patients with LVEF ≤60%, a significant increase in GLS after TAVR was observed (−9.6±4.1% versus −12.1±3.3%; p=0.0039). Improvement in GLS according to the LVEF Conclusion Following TAVR, an early improvement in LV systolic function assessed by GLS was observed only in patients with pre-existing mild LV systolic dysfunction. Further studies should evaluate whether this improvement is associated with better long term outcome.

scholarly journals Influence of Myocardial Fibrosis on Left Ventricular Hypertrophy in Patients with Symptomatic Severe Aortic Stenosis

Cardiology ◽  
2011 ◽  
Vol 120 (3) ◽  
pp. 139-145 ◽  
Author(s):  
Giorgio Golia ◽  
Aldo D. Milano ◽  
Mikhail Dodonov ◽  
Corinna Bergamini ◽  
Giuseppe Faggian ◽  
...  
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Ventricular Hypertrophy ◽  
Severe Aortic Stenosis ◽  
Left Ventricular

scholarly journals Echocardiographic global longitudinal strain as a marker of myocardial fibrosis predicts outcomes in aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Chin ◽  
T T Le ◽  
G Singh ◽  
J Yip ◽  
S C Chai ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Confidence Interval ◽  
Myocardial Fibrosis ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Derivation Cohort ◽  
Replacement Fibrosis

Abstract Background Left ventricular global longitudinal strain (LV-GLS) by speckle tracking echocardiography (STE) reflects intrinsic myocardial function, influenced by interstitial abnormalities. Cardiovascular magnetic resonance (CMR) detects myocardial fibrosis non-invasively, but it is limited for widespread use. We aim to establish LV-GLS as a marker of replacement myocardial fibrosis on CMR and validate the prognostic value of LV-GLS thresholds associated with fibrosis. Methods LV-GLS thresholds of replacement fibrosis were established in the derivation cohort: 151 patients (57±10 years; 58% males) with hypertension who underwent STE to measure LV-GLS and CMR for replacement myocardial fibrosis. Prognostic value of the thresholds was validated in a separate outcome cohort: 261 patients with moderate-severe aortic stenosis (AS; 71±12 years; 58% males; NYHA functional class I-II) and preserved LVEF ≥50%. Primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, myocardial infarction and cerebrovascular events. Results In the derivation cohort, LV-GLS demonstrated good discrimination (c-statistics 0.74; 95% confidence interval: 0.66–0.83; P&lt;0.001) and calibration (Hosmer-Lemeshow X2=6.37; P=0.605) for replacement fibrosis. In the outcome cohort, 52 events occurred over 16 [3.1, 42.0] months of follow-up. Patients with LV-GLS &gt;−15.0% (corresponding to 95% specificity to rule-in myocardial fibrosis) had the worst outcomes compared to patients with LV-GLS &lt;−21.0% (corresponding to 95% sensitivity to rule-out myocardial fibrosis) and those between −21.0 and −15.0% (log-rank P&lt;0.001; Figure 1). Furthermore, LV-GLS offered independent prognostic value over clinical variables, AS severity, echocardiographic LVEF and E/e' (hazard ratio 1.18; 95% confidence interval: 1.07 to 1.30; P=0.001). Conclusions LV-GLS thresholds associated with replacement myocardial fibrosis is a novel approach to risk-stratify patients with AS and preserved LVEF (Figure 2). FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Medical Research Council Figure 1 Figure 2

Left ventricular twist predicts mortality in severe aortic stenosis

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318800
Author(s):  
Ladina Erhart ◽  
Thierry Donati ◽  
Shehab Anwer ◽  
Matthias Schindler ◽  
Miriam Gremminger ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Cox Regression ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cox Regression Analysis ◽  
Ventricular Mechanics ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Twist ◽  
All Cause Mortality

ObjectiveLeft ventricular (LV) twist is a major component of ventricular mechanics reflecting the helical orientation of cardiac fibres and compensating for afterload mismatch. However, it is not known whether it determines outcome after transcatheter aortic valve implantation (TAVI). This study sought to investigate TAVI-induced short-term changes of LV twist and to define its role in outcome prediction.MethodsA total of 146 patients (median age 81.78 years, 50.7% male) undergoing TAVI for severe aortic stenosis were included. LV rotation and twist were determined by speckle tracking echocardiography within 3 months before and 2 weeks after TAVI. All-cause mortality at 2 years was defined as primary end point.ResultsPatients who survived exhibited a higher apical peak systolic rotation (APSR) (p<0.001), twist (p=0.003) and torsion (p=0.019) pre-TAVI compared with those who died (n=22). Within 2 weeks after TAVI, APSR, twist and torsion decreased in patients who survived (all p<0.001), while no change occurred in those who died. Cox regression analysis showed an association of pre-TAVI APSR (HR 0.92, p=0.010), twist (HR 0.93, p=0.018) and torsion (HR 0.68, p=0.040) with all-cause mortality and an even stronger association of the respective changes after TAVI (∆APSR: HR 1.15, p<0.001; ∆twist: HR 1.14, p<0.001; ∆torsion: HR 2.53, p<0.001). All the parameters determined outcome independently of global longitudinal strain (GLS) and LV ejection fraction (LVEF).ConclusionAPSR, twist and torsion pre-TAVI as well as their change within 2 weeks after TAVI predict 2-year all-cause mortality after TAVI, adding incremental prognostic value to LVEF and GLS.

scholarly journals The association of left ventricular histologically verified myocardial fibrosis with pulmonary hypertension in severe aortic stenosis

Perfusion ◽  
2021 ◽  
pp. 026765912110427
Author(s):  
Birute Gumauskiene ◽  
Egle Drebickaite ◽  
Dalia Pangonyte ◽  
Jolanta Justina Vaskelyte ◽  
Lina Padervinskiene ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Functional Markers ◽  
2D Echocardiography

Objectives: To evaluate the association between histologically verified left ventricular (LV) myocardial fibrosis (MF) and its bio- and functional markers with pulmonary hypertension (PH) in severe aortic stenosis (AS). Methods: About 34 patients with isolated severe AS underwent 2D echocardiography, cardiac magnetic resonance (CMR) imaging, and plasma NT-proBNP evaluation before aortic valve replacement (AVR). LV measurements were analyzed by CMR and LV strain using feature tracking software (Medis Suite QStrain 2.0). Myocardial biopsy sampled at the time of AVR was assessed by a histomorphometric analysis. PH was defined as pulmonary artery systolic pressure (PASP) ⩾ 45 mm Hg. Results: Patients with severe AS and PH (mean PASP 53 ± 3.7 mm Hg) had higher extent of diffuse MF versus patients without PH (12 (10.4–12.7)% vs 6.6 (4.6–8.2)% (p = 0.00)). The extent of diffuse MF correlated with LV dilatation ( r = 0.7, p = 0.02), indices of LV dysfunction (lower ejection fraction ( r = −0.6, p < 0.001), global longitudinal ( r = −0.5, p = 0.02) and circumferential strain ( r = −0.5, p = 0.05), elevated NT-proBNP ( r = 0.5, p = 0.005) and elevated PASP ( r = 0.6, p < 0.001)). Histological MF > 10% (AUC 94.9%), LV global longitudinal strain > −15.5% (AUC 86.3%), and NT-proBNP > 2090 ng/l (AUC 85.1%) were independent predictors of PH in severe AS. Conclusions: The extent of diffuse myocardial fibrosis in combination with reduced longitudinal left ventricular strain and increased plasma levels of NT-proBNP relates to pulmonary hypertension in severe aortic stenosis.

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