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 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.

scholarly journals 657 Right ventricle systolic function and RV-PA coupling in patients with severe aortic stenosis and the early impact of TAVI

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Rosa Lillo ◽  
Francesca Graziani ◽  
Gessica Ingrasciotta ◽  
Bianca Przbybylek ◽  
Giulia Iannaccone ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricle ◽  
Diastolic Function ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Early Effect ◽  
Few Data

Abstract Aims Few data are available on the prevalence of right ventricle (RV) systolic dysfunction, assessed including RV strain, and RV to pulmonary artery (PA) coupling in patients with aortic stenosis (AS) submitted to TAVI and the early effect of the procedure. Methods We performed standard and speckle tracking echocardiography in 80 patients with severe AS the day before TAVI and within 48 h after TAVI. In all patients we measured TAPSE/PASP (cut-off for RV-PA uncoupling 0.31) and in 60/80 we were able to analyse RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS). Results RV-FAC and TAPSE were impaired in 8.3% while RV-GLS and RV-FWS in 45% and 33% before TAVI. TAPSE/PASP&lt;0.31 was documented in 7/80 patients (8.7%) before TAVI. These subjects differed from patients with TAPSE/PASP&gt;0.31 for: enlarged left ventricular (LV) end-diastolic and end-systolic volumes (P&lt;0.001), worst LVEF (P&lt;0.001) and RVFAC (P&lt;0.001), worst RV-GLS and RW-FWS (P=0.01 and P=0.03) and bigger right atrium (RA) area (P&lt;0.001). After TAVI, RV systolic function did not improve while PASP significantly decreased (P=0.005) driving the improvement of TAPSE/PASP (P=0.01). Patients with TAPSE/PASP improvement (51%) differed from the others for worst pre-TAVI diastolic function (E/e’ P=0.045), RV-FAC (P=0.042), RV-GLS (P=0.049) and RA area (P=0.02). Conclusions RV-GLS unveils RV systolic dysfunction in as much as 45% of patients with AS vs. only 8.3% revealed by conventional echocardiography. RV systolic function does not significantly improve early after TAVI while RV-PA coupling does. Patients with lower TAPSE/PASP at baseline have worst LV and RV systolic function as well as larger RA. Patients who improve TAPSE/PASP after TAVI are those with worst diastolic function, RV systolic function and larger RA at baseline.

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

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.

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

scholarly journals The signifi cance of global longitudinal strain of left ventricular in the classifi cation of stages of aortic stenosis based on the extravalvular cardiac damage

2021 ◽  
Vol 99 (3) ◽  
pp. 187-191
Author(s):  
M. G. Matveeva ◽  
M. N. Alekhin
Keyword(s):  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Stage 4 ◽  
The Right ◽  
Stage 1

Severe aortic stenosis (AS) is characterized not only by degenerative changes in the aortic valve but also by extravalvular cardiac damage. Recently, a new staging classifi cation of AS has been proposed based on the extent of cardiac damage, as well as its modifi ed variants with the addition of a measure of global longitudinal strain of the left ventricular (GLS LV), as an earlier predictor of preclinical LV systolic dysfunction.Aim. To evaluate the signifi cance of GLS LV in the staging classifi cation of AS based on the extent of cardiac damage according to a multidisciplinary hospital.Мaterials and methods. 66 patients with severe AS with available GLS LV by speckle tracking echocardiography were selected and analyzed retrospectively.Results. Patients were categorized according to cardiac damage on ECHO: stage 0 was determined in 2 (3%) patients; stage 1 — 10 (15%), stage 2 — 41 (62%), stage 3 — 13 (20%). The use of staging classifi cation of AS with addition of GLS LV quintiles led to patient reclassifi cation. Thus, stage 4 included patients from stage 2 and stage 3 cardiac damage.Conclusions. In patients with severe AS, the adding the GLS LV to the routine ECHO can help to more accurately determine the stages of AS and make the right decision on the management tactics of such patients.

Sign in / Sign up

Export Citation Format

Share Document