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Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Flett, Andrew S. Sado, Daniel M. Quarta, Giovanni Mirabel, Mariana Pellerin, Denis Herrey, Anna S. Hausenloy, Derek J. Ariti, Cono Yap, John Kolvekar, Shyam Taylor, Andrew M. Moon, James C.
Description	Country affiliation: United kingdom Author Affiliation: Flett AS ( The Heart Hospital, University College London Hospitals NHS Trust, 16-18 Westmoreland Street, London W1G 8PH, UK.)
Abstract	AIMS: Haemodynamics alone do not fully explain symptoms and prognosis in clinically severe aortic stenosis (AS). Myocardial disease, specifically diffuse myocardial fibrosis (DMF), may contribute. We used equilibrium contrast cardiovascular magnetic resonance (EQ-CMR) and sought to non-invasively measure DMF in severe AS and determine its clinical significance before and after valve replacement. METHODS AND RESULTS: Patients with severe AS underwent echocardiography, brain natriuretic peptide (BNP), 6 min walk test (6MWT), and EQ-CMR pre- (n = 63) at baseline and at 6 months post- (n = 42) aortic valve replacement (AVR). EQ-CMR was also performed in 30 normal controls. Baseline: patients with AS had more DMF than controls (18 vs. 13%, P = 0.007) with a wide range (5-38%) that overlapped controls. The extent of diffuse fibrosis correlated inversely with the 6MWT performance (r(2) = 0.22, P = 0.001). Those with severe diastolic dysfunction had more DMF (P = 0.01). On multivariable analysis, the predictors of performance at 6MWT were diffuse fibrosis and BNP (P = 0.003 and 0.02, respectively). Post-op: following valve replacement, morphological and functional parameters improved [6 MWT, LA area, BNP, left ventricular (LV) hypertrophy, and volumes]. LV hypertrophy regression was shown to be cell volume reduction (P < 0.001) and not fibrosis regression (P = 0.54). Of the five deaths over six-month follow-up, four occurred in patients in the highest tertile of DMF. CONCLUSION: DMF as measured by EQ-CMR is elevated in severe AS vs. normal controls but with a considerable overlap. It correlates with functional capacity at baseline. LV hypertrophy regression 6 months after AVR is cellular rather than fibrosis resolution.
File Format	HTM / HTML
ISSN	20472404
e-ISSN	20472412
Journal	European Heart Journal - Cardiovascular Imaging features
Issue Number	10
Volume Number	13
Language	English
Publisher	Oxford University Press
Publisher Date	2012-10-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Cardiology Aortic Valve Stenosis Diagnosis Contrast Media Endomyocardial Fibrosis Magnetic Resonance Imaging, Cine Pathology Surgery Disease Progression Exercise Tolerance Hemodynamics Hypertrophy, Left Ventricular Prognosis Prospective Studies Severity Of Illness Index Statistics As Topic Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Cardiology and Cardiovascular Medicine

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Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study.

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