Lee Hyun-Jung, Singh Anvesha, Lim Jaehyun, Craig Neil, Bing Rong, Tastet Lionel, Park Jun-Bean, Kim Hyung-Kwan, Kim Yong-Jin, Clavel Marie-Annick, Gerber Bernhard L, McCann Gerry P, Dweck Marc R, Pibarot Phillipe, Lee Seung-Pyo
Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, United Kingdom.
JACC Cardiovasc Imaging. 2025 Feb;18(2):180-191. doi: 10.1016/j.jcmg.2024.08.003. Epub 2024 Sep 25.
Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events.
The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS.
A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm) or asymptomatic severe AS (AVA ≤1.0 cm and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission.
Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05).
Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.
中度或无症状重度主动脉瓣狭窄（AS）患者存在心血管事件风险。
作者研究了心脏磁共振成像（CMR）在识别中度或无症状重度AS患者预后驱动因素方面的作用。
一项前瞻性、国际性、多中心队列研究（n = 457），纳入中度（主动脉瓣面积[AVA]：1.0 - 1.5 cm²）或无症状重度AS（AVA≤1.0 cm²且纽约心脏协会[NYHA]心功能分级I - II级）患者，对其进行CMR检查。采用细胞外容积分数（ECV%）和延迟钆增强（LGE）分析心肌弥漫性间质纤维化和瘢痕情况。结局指标为死亡率和因心力衰竭入院的复合指标。
ECV%中位数为26.6%（四分位间距：24.4% - 29.9%），31.5%的患者存在LGE（中位数0.8%；四分位间距：0.1% - 1.7%）。AS严重程度越高，左心室质量和舒张功能障碍越严重，但与ECV%或LGE无关。在中位随访5.7年期间，发生了83起事件。发生事件的患者ECV%更高（ECV%中位数26.3%对28.2%；P = 0.003）。在整个队列以及NYHA心功能分级I级的中度或重度AS患者中，ECV%最高三分位数（ECV% > 28.6%）的患者预后更差，且ECV%与结局独立相关（校正后风险比：1.05；P = 0.039）。当将ECV%添加到AS严重程度、心功能参数、合并症、主动脉瓣置换和LGE等参数中时，其具有显著的增量预后价值（P < 0.05）。
心肌弥漫性间质纤维化增加与中度和无症状重度AS患者的不良预后相关，有助于识别那些需要密切监测不良结局的患者。
