scholarly journals Myocardial extracellular volume fraction and myocardial fibrosis by cmr in patients with severe aortic stenosis

2015 ◽  
Vol 17 (S1) ◽  
Author(s):  
Gabriela Liberato ◽  
Juliana Bello ◽  
Rodrigo D Melo ◽  
Antonildes N Assunção Jr ◽  
Ariane B Pacheco ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction

T1 Mapping for Noninvasively Detecting Diffuse Fibrosis in Severe Aortic Stenosis

2020 ◽  
Vol 10 (7) ◽  
pp. 1534-1539
Author(s):  
Jiajun Xie ◽  
Xuhua Jian ◽  
Qiyang Lu ◽  
Jinxiu Meng ◽  
Yu-Hsiang Juan ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Cardiac Mri ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Diffuse Fibrosis ◽  
Mapping Technique

Purpose: To evaluate myocardial diffuse fibrosis in severe aortic stenosis (SAS) with cardiac magnetic resonance imaging (MRI) T1 mapping technique. Methods: Twenty-seven SAS patients and 15 controls were enrolled and performed cardiac MRI. Left ventricular (LV) structure, function and T1-derived parameters were measured to compare between SAS group and the controls. Correlation between T1-derived parameters and the extent of histologic fibrosis was performed in 15 patients who underwent aortic valve replacement surgery and myocardial biopsy. Results: The SAS group had LV remodeling with ventricular dilatation, hypertrophy, and contractile dysfunction. The native T1 (1336.2±62.5 ms vs. 1277.6±40.7 ms, p = 0.002) and extracellular volume fraction (ECV%) (26.7±2.2% vs. 24.9±2.2%, p = 0.018) were elevated in the SAS in comparison to the controls. Only ECV and λ correlated with the extent of fibrosis as measured by histology. Conclusion: Cardiac MRI with T1 mapping provides a noninvasive approach to evaluate LV myocardial diffuse fibrosis in SAS.

scholarly journals Prognostic Impact of Myocardial Extracellular Volume Fraction Assessment Using Dual‐Energy Computed Tomography in Patients Treated With Aortic Valve Replacement for Severe Aortic Stenosis

2021 ◽  
Author(s):  
Masataka Suzuki ◽  
Takayoshi Toba ◽  
Yu Izawa ◽  
Hiroshi Fujita ◽  
Keisuke Miwa ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Volume Fraction ◽  
Independent Predictor ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Dual Energy ◽  
Adverse Outcomes ◽  
Dual Energy Ct

Background Myocardial extracellular volume fraction (ECV), measured by cardiac magnetic resonance imaging, is a useful prognostic marker for patients who have undergone aortic valve replacement (AVR) for aortic stenosis. However, the prognostic significance of ECV measurements based on computed tomography (CT) is unclear. This study evaluated the association between ECV measured with dual‐energy CT and clinical outcomes in patients with aortic stenosis who underwent transcatheter or surgical AVR. Methods and Results We retrospectively enrolled 95 consecutive patients (age, 84.0±5.0 years; 75% women) with severe aortic stenosis who underwent preprocedural CT for transcatheter AVR planning. ECV was measured using iodine density images obtained by delayed enhancement dual‐energy CT. The primary end point was a composite outcome of all‐cause death and hospitalization for heart failure after AVR. The mean ECV measured with CT was 28.1±3.8%. During a median follow‐up of 2.6 years, 22 composite outcomes were observed, including 15 all‐cause deaths and 11 hospitalizations for heart failure. In Kaplan‐Meier analysis, the high ECV group (≥27.8% [median value]) had significantly higher rates of composite outcomes than the low ECV group (<27.8%) (log‐rank test, P =0.012). ECV was the only independent predictor of adverse outcomes on multivariable Cox regression analysis (hazards ratio, 1.25; 95% CI, 1.10‒1.41; P <0.001). Conclusions Myocardial ECV measured with dual‐energy CT in patients who underwent aortic valve intervention was an independent predictor of adverse outcomes after AVR.

scholarly journals Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248306
Author(s):  
Yoav Hammer ◽  
Yeela Talmor-Barkan ◽  
Aryeh Abelow ◽  
Katia Orvin ◽  
Yaron Aviv ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Normal Subjects ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Galectin 3

Background The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Methods Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Results Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65–0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. Conclusion In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.

scholarly journals CMR Diffusion Tensor Imaging Provides Novel Imaging Markers of Adverse Myocardial Remodeling in Aortic Stenosis

2020 ◽  
Author(s):  
Alexander Gotschy ◽  
Constantin von Deuster ◽  
Lucas Weber ◽  
Mareike Gastl ◽  
Martin O. Schmiady ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Aortic Stenosis ◽  
Valve Replacement ◽  
Myocardial Fibrosis ◽  
Diffusion Tensor ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Mean Diffusivity ◽  
Diffuse Fibrosis ◽  
Native T1

Objectives - This study sought to determine microstructural cardiac remodeling in aortic stenosis (AS) and its reversibility following valve replacement using cardiovascular magnetic resonance (CMR) diffusion tensor imaging (DTI). Background - Myocardial involvement in AS, such as focal and diffuse fibrosis is associated with worse outcome, even after timely aortic valve replacement (AVR). Alterations of myofiber architecture and myocardial diffusion may precede fibrosis, but its extent and reversibility after AVR are unknown. Methods - Patients with isolated severe AS (n=21, 62% male; mean age 75 years) and sex-matched senior control subjects underwent prospective CMR DTI. Changes in the DTI parameters: mean diffusivity (MD), fractional anisotropy (FA) as well as helix angle (HA) and absolute E2A sheet angle (E2A) were quantified and compared with native T1 and extracellular volume (ECV) as standard CMR markers of myocardial fibrosis. Six months after AVR eleven patients were scheduled for a follow-up CMR. Results - In AS patients, significantly elevated MD (p=0.002) and reduced FA (p<0.001) were measured when compared to controls. Myocyte aggregate orientation exhibited a steeper transmural HA slope (p<0.001) and increased absolute E2A sheet angle (p<0.001) in AS. Six months post AVR, the HA slope (p<0.001) was reduced to the level of healthy controls and MD (p=0.014), FA (p=0.011) and E2A (p=0.003) showed a significant regression towards normal values. In contrast, native T1 was similar in AS and controls and did not change significantly after AVR. ECV showed a non-significant trend (p=0.16) to higher values after AVR. Conclusion - In patients with severe aortic stenosis, CMR DTI provides a set of parameters that identifies structural and diffusion abnormalities, which are largely reversible after AVR. DTI parameters showed proportionally greater changes in response to AS and AVR compared to metrics of myocardial fibrosis and may, therefore, aid risk stratification in earlier stages of severe AS.

Exploring myocardial fibrosis in severe aortic stenosis: echo, CMR and histology data from FIB-AS study

2021 ◽  
Author(s):  
Giedrė Balčiūnaitė ◽  
Justinas Besusparis ◽  
Darius Palionis ◽  
Edvardas Žurauskas ◽  
Viktor Skorniakov ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Surrogate Marker ◽  
Serum Biomarkers ◽  
Cardiac Remodelling ◽  
Native T1

Abstract PurposeMyocardial fibrosis in aortic stenosis (AS) is associated with worse survival following aortic valve replacement (AVR). We assessed myocardial fibrosis in severe AS patients, integrating echocardiographic, cardiovascular magnetic resonance (CMR) and histological data. MethodsA total of 83 severe AS patients (age 66.4 ± 8.3, 42% male) who were scheduled for surgical AVR underwent CMR with late gadolinium enhancement (LGE) and T1 mapping and global longitudinal strain (GLS) analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies (71) that were sampled at the time of AVR. ResultsCVF correlated with imaging and serum biomarkers of LV systolic dysfunction and left side chamber enlargement and was higher in the sub-endocardium compared with midmyocardium (p<0.001). CVF median values were higher in LGE-positive versus LGE-negative patients [28.7% (19-33) vs 20.7% (15-30), respectively, p=0.040]. GLS was associated with invasively (CVF; r=-0.303, p=0.013) and non-invasively (native T1; r=-0.321, p<0.05) measured myocardial fibrosis. GLS and native T1 correlated with parameters of adverse LV remodelling, systolic and diastolic dysfunction and serum biomarkers of heart failure and myocardial injury. ConclusionOur data highlight the role of myocardial fibrosis in adverse cardiac remodelling in AS. GLS has potential as a surrogate marker of myocardial fibrosis, and high native T1 and low GLS values differentiated patients with more advanced cardiac remodelling.

scholarly journals CMR–Derived Extracellular Volume Fraction as a Marker for Myocardial Fibrosis

2018 ◽  
Vol 11 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Julia Anna Lurz ◽  
Christian Luecke ◽  
David Lang ◽  
Christian Besler ◽  
Karl-Philipp Rommel ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction

scholarly journals Extracellular volume fraction by T1 mapping predicts omprovement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic cardiomyopathy and atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Azuma ◽  
S Kato ◽  
S Kodama ◽  
K Hayakawa ◽  
M Kagimoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Myocardial Fibrosis ◽  
T1 Mapping ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Risk Of Death

Abstract Background The Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial has shown that the catheter ablation (CA) for atrial fibrillation (AF) significantly reduced the risk of death and hospitalization for heart failure in patients with non-ischemic dilated cardiomyopathy (NIDCM) and AF (N Engl J Med 2018; 378:417–27). In addition, the Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI) study demonstrated that the absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after CA in NIDCM patients with AF (J Am Coll Cardiol 2017; 70:1949–61). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify diffuse myocardial fibrosis. Purpose The aim of this study was to compare the predictive value of LGE-MRI and ECV by T1 mapping for the prediction of improvement of LVEF after CA in NIDCM patients. Methods A total of twenty-eight patients with NIDCM and AF (age: 67±10 years; 25 (89%) male; LVEF: 34.1±8.8%) were studied. Using a 1.5T MR scanner and 32 channel cardiac coils, cine MRI, LGE-MRI, pre- and post- T1 mapping images of LV wall at mid-ventricular level (modified Look-Locker inversion recovery sequence) were acquired. Myocardial fibrosis on LGE was defined as area with &gt;5SD signal intensity of normal myocardium. ECV from six segments of mid ventricular level were averaged for each patient. All patients underwent CA for AF, and the improvement of LVEF before and after CA were evaluated by echocardiography. Results All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 34.1±8.8% before CA and 49.1±12.0% after CA (p&lt;0.001), resulting an improvement of 15.0±11.8%. Significant correlation was found between improvements in LVEF and amount of fibrosis on LGE-MRI (r=−0.40, p=0.034), improvement of LVEF and ECV (r=−0.55, p=0.008). In the ROC analysis, ECV had a higher discriminative ability for the improvement of LVEF after CA compared with amount of fibrosis on LGE-MRI (AUC 0.885 vs 0.650) (Figure). Conclusions In NIDCM patients with AF, ECV by T1 mapping had better predictive ability for improvement of LVEF after CA in comparison to LGE-MRI. ROC curves of ECV and LGE-MRI Funding Acknowledgement Type of funding source: None

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