Royal Brompton Hospital, London, United Kingdom.
J Am Coll Cardiol. 2011 Sep 13;58(12):1271-9. doi: 10.1016/j.jacc.2011.03.064.
The goal of this study was to assess the prognostic significance of midwall and infarct patterns of late gadolinium enhancement (LGE) in aortic stenosis.
Myocardial fibrosis occurs in aortic stenosis as part of the hypertrophic response. It can be detected by LGE, which is associated with an adverse prognosis in a range of other cardiac conditions.
Between January 2003 and October 2008, consecutive patients with moderate or severe aortic stenosis undergoing cardiovascular magnetic resonance with administration of gadolinium contrast were enrolled into a registry. Patients were categorized into absent, midwall, or infarct patterns of LGE by blinded independent observers. Patient follow-up was completed using patient questionnaires, source record data, and the National Strategic Tracing Service.
A total of 143 patients (age 68 ± 14 years; 97 male) were followed up for 2.0 ± 1.4 years. Seventy-two underwent aortic valve replacement, and 27 died (24 cardiac, 3 sudden cardiac deaths). Compared with those with no LGE (n = 49), univariate analysis revealed that patients with midwall fibrosis (n = 54) had an 8-fold increase in all-cause mortality despite similar aortic stenosis severity and coronary artery disease burden. Patients with an infarct pattern (n = 40) had a 6-fold increase. Midwall fibrosis (hazard ratio: 5.35; 95% confidence interval: 1.16 to 24.56; p = 0.03) and ejection fraction (hazard ratio: 0.96; 95% confidence interval: 0.94 to 0.99; p = 0.01) were independent predictors of all-cause mortality by multivariate analysis.
Midwall fibrosis was an independent predictor of mortality in patients with moderate and severe aortic stenosis. It has incremental prognostic value to ejection fraction and may provide a useful method of risk stratification.
本研究旨在评估晚期钆增强（LGE）心肌壁和梗死模式在主动脉瓣狭窄中的预后意义。
心肌纤维化是主动脉瓣狭窄中肥厚反应的一部分。LGE 可检测到心肌纤维化，这与一系列其他心脏疾病的不良预后相关。
2003 年 1 月至 2008 年 10 月，连续接受心血管磁共振检查并给予钆对比剂的中重度主动脉瓣狭窄患者被纳入登记。通过盲法独立观察者将患者分为 LGE 无、壁心肌和梗死模式。通过患者问卷、源记录数据和国家战略追踪服务完成患者随访。
共纳入 143 例患者（年龄 68 ± 14 岁；97 例男性），随访 2.0 ± 1.4 年。72 例行主动脉瓣置换术，27 例死亡（24 例心脏性，3 例心脏性猝死）。与无 LGE 患者（n = 49）相比，单因素分析显示，尽管主动脉瓣狭窄严重程度和冠状动脉疾病负担相似，壁心肌纤维化患者（n = 54）的全因死亡率增加 8 倍。梗死模式患者（n = 40）的死亡率增加了 6 倍。多因素分析显示，壁心肌纤维化（危险比：5.35；95%置信区间：1.16 至 24.56；p = 0.03）和射血分数（危险比：0.96；95%置信区间：0.94 至 0.99；p = 0.01）是全因死亡率的独立预测因素。
壁心肌纤维化是中重度主动脉瓣狭窄患者死亡的独立预测因素。它对射血分数具有增量预后价值，并可能提供一种有用的风险分层方法。
