Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal.
Int J Cardiol. 2023 May 1;378:159-163. doi: 10.1016/j.ijcard.2023.02.034. Epub 2023 Feb 22.
Left ventricular (LV) remodeling in severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response. Reparative/replacement fibrosis is considered irreversible and has recognized value in both risk stratification and prognosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for fibrosis identification through late gadolinium enhancement (LGE) assessment. However, its prevalence and distribution are quite variable among series. Our goal was to assess LGE prevalence and patterns in severe AS.
Single-center prospective cohort of 140 patients with severe symptomatic high-gradient AS (mean age 72 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean LV ejection fraction by echocardiogram 58 ± 9%) undergoing surgical aortic valve replacement. Those with previous myocardial infarction and/or non-ischemic cardiomyopathy were excluded. All patients performed 1.5 T LGE-CMR prior to surgery.
Overall, 103 patients (74%) had non-ischemic LGE (median LGE mass 2.8 g [IQR 0.0-7.8] g), many of them with combined mid-wall and junctional enhancement pattern (36%). LGE was most frequently observed in the mid-basal segments of the interventricular septum. Seventy-four patients (53%) had non-exclusively junctional LGE. Contrary to those with junctional enhancement, patients with non-exclusively junctional LGE had higher LV volumes/mass, worse LV ejection fraction and worse global longitudinal strain.
Among patients with severe, symptomatic, high-gradient AS, LGE is frequent, primarily affecting the mid-basal interventricular septum. Contrary to junctional LGE, the presence of non-junctional LGE seems to correlate with adverse markers of LV remodeling.
严重主动脉瓣狭窄（AS）患者的左心室（LV）重构是一个复杂的过程，不仅仅是肥厚反应。修复/替代纤维化被认为是不可逆的，在风险分层和预后方面都具有重要价值。目前，心脏磁共振（CMR）是通过晚期钆增强（LGE）评估识别纤维化的金标准成像技术。然而，其在不同系列中的发生率和分布差异很大。我们的目标是评估严重 AS 中的 LGE 发生率和模式。
对 140 例严重症状性高梯度 AS 患者（平均年龄 72±8 岁；平均跨主动脉瓣梯度 61±18mmHg；超声心动图检查平均左心室射血分数 58±9%）进行单中心前瞻性队列研究。排除有先前心肌梗死和/或非缺血性心肌病的患者。所有患者在手术前均进行 1.5T LGE-CMR。
总体而言，103 例（74%）患者存在非缺血性 LGE（中位数 LGE 质量为 2.8g[IQR 0.0-7.8]g），其中许多患者存在中壁和交界区强化模式（36%）。LGE 最常见于室间隔中基底段。74 例（53%）患者存在非局限性交界区 LGE。与交界区强化的患者相比，非局限性交界区 LGE 患者的 LV 容积/质量更高，左心室射血分数和整体纵向应变更差。
在严重、有症状、高梯度 AS 患者中，LGE 很常见，主要影响中基底室间隔。与交界区 LGE 相反，非交界区 LGE 的存在似乎与 LV 重构的不良标志物相关。
