Orłowska-Baranowska Ewa, Nieznańska Małgorzata, Marczak Magdalena, Śpiewak Mateusz, Mazurkiewicz Łukasz, Miłosz Barbara, Zatorska Karina, Kowalik Ilona, Baranowski Rafał, Hryniewiecki Tomasz
Department of Valvular Heart Disease, National Institute of Cardiology, Warszawa, Poland.
Magnetic Resonance Unit, National Institute of Cardiology, Warszawa, Poland.
Kardiol Pol. 2024;82(12):1211-1219. doi: 10.33963/v.phj.102581. Epub 2024 Oct 8.
It remains a challenge to determine the best time to refer asymptomatic patients for aortic valve replacement (AVR).
We aimed to determine whether late gadolinium enhancement (LGE) in patients with asymptomatic aortic stenosis (AS) has an independent prognostic significance for adverse postoperative cardiovascular events and changes in left ventricular (LV) hypertrophy (LVH) and LV ejection fraction (LVEF).
Consecutive patients with severe asymptomatic AS were prospectively enrolled in the study. All patients underwent cardiovascular magnetic resonance with LGE assessment. Patients were followed up every 6 months, and immediately after the onset of symptoms, they were referred for AVR. Early outcomes, as well as LVH and LVEF in the follow-up after AVR, were compared between patients with and without LGE.
Ninety-one patients (34 females, 57 males, median [interquartile range] age: 59.2 [56.9-61.6] years) were evaluated, and 68 persons (75%) were treated with AVR. LGE patients (LGE+) developed symptoms earlier than patients without LGE (LGE-, median [interquartile range]: 18 [7-34] months vs. 28 [14-47] months; P = 0.01), but there were no differences in early complications (P = 0.14) and LVEF (P = 0.47) post-AVR between the groups. One year after AVR, no differences were observed between LGE+ and LGE- patients with regard to LV posterior wall thickness (P = 0.26), interventricular septum thickness (P = 0.16), and LVEF (P = 0.9).
The outcome for patients with asymptomatic AS but with LGE was similar to this observed in the non-LGE group. Watchful waiting in this group, with referral to AVR immediately after symptom onset, is associated with comparable results as in LGE- patients.
确定将无症状患者转诊进行主动脉瓣置换术（AVR）的最佳时机仍然是一项挑战。
我们旨在确定无症状主动脉瓣狭窄（AS）患者的延迟钆增强（LGE）对术后不良心血管事件以及左心室（LV）肥厚（LVH）和左心室射血分数（LVEF）变化是否具有独立的预后意义。
连续纳入重度无症状AS患者进行前瞻性研究。所有患者均接受了带有LGE评估的心血管磁共振检查。每6个月对患者进行随访，症状出现后立即转诊进行AVR。比较有和没有LGE的患者的早期结局以及AVR后随访中的LVH和LVEF。
评估了91例患者（34例女性，57例男性，中位[四分位间距]年龄：59.2[56.9 - 61.6]岁），68人（75%）接受了AVR治疗。有LGE的患者（LGE +）比没有LGE的患者（LGE -）更早出现症状（中位[四分位间距]：18[7 - 34]个月对28[14 - 47]个月；P = 0.01），但两组之间AVR后的早期并发症（P = 0.14）和LVEF（P = 0.47）没有差异。AVR后一年，LGE +和LGE -患者在左心室后壁厚度（P = 0.26）、室间隔厚度（P = 0.16）和LVEF（P = 0.9）方面没有差异。
无症状AS但有LGE的患者的结局与非LGE组中观察到的相似。该组患者进行密切观察，症状出现后立即转诊进行AVR，其结果与LGE -患者相当。
