Myhr Katrine Aagaard, Andrés-Jensen Liv, Larsen Bjørn Strøier, Kristensen Charlotte Burup, Køber Nana, Tischer Susanne Glasius, Sørensen Lars Lindholm, Schmiegelov Søren Skøtt, Linde Jesper James, Vejlstrup Niels Grove, Dahl Jordi Sanchez, Køber Lars, Pecini Redi
Department of Cardiology, The Heart Centre, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, 2100, Copenhagen, Denmark.
Department of Pediatric Hematology/Oncology, Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Int J Cardiovasc Imaging. 2025 Sep 18. doi: 10.1007/s10554-025-03519-2.
Purpose The degree of myocardial fibrosis may guide the timing of aortic valve replacement in patients with severe asymptomatic aortic valve stenosis (AS). We aimed to examine the prevalence and degree of myocardial fibrosis in severe asymptomatic AS compared with severe symptomatic AS. Methods We prospectively included 42 patients with severe asymptomatic AS and 80 patients with severe symptomatic AS, all with a left ventricular ejection fraction ≥ 50% and no ischemic heart disease. All patients underwent a standard cardiac magnetic resonance examination, including native T1 mapping. Gadolinium contrast was administered to evaluate extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). Results There were no differences in myocardial fibrosis markers when comparing symptomatic with asymptomatic patients and adjusting for sex, age, and aortic peak velocity, including native T1 (mean difference [MD] -1 ms; 95% confidence interval [CI] -11 to 10; p = 0.90), ECV% (MD 0.2%; 95% CI -1 to 1; p = 0.65), LGE prevalence (odd ratio [OR] 1.2; 95% CI 0.4 to 3.3; p = 0.72), and a combined binary high- or low-grade fibrosis parameter (OR 1.1; 95% CI 0.3 to 4.0; p = 0.94). Conclusion Patients with severe asymptomatic AS exhibited similar severity of myocardial fibrosis markers as those with severe symptomatic AS, suggesting that substantial myocardial damage precedes symptom development.
目的 心肌纤维化程度可能指导重度无症状主动脉瓣狭窄（AS）患者进行主动脉瓣置换的时机。我们旨在研究重度无症状AS与重度有症状AS中心肌纤维化的患病率及程度，并进行比较。方法 我们前瞻性纳入了42例重度无症状AS患者和80例重度有症状AS患者，所有患者左心室射血分数≥50%且无缺血性心脏病。所有患者均接受了标准的心脏磁共振检查，包括原生T1映射。给予钆对比剂以评估细胞外容积分数（ECV%）和延迟钆增强（LGE）。结果 在比较有症状和无症状患者，并对性别、年龄和主动脉峰值流速进行校正后，心肌纤维化标志物没有差异，包括原生T1（平均差[MD] -1毫秒；95%置信区间[CI] -11至10；p = 0.90）、ECV%（MD 0.2%；95% CI -1至1；p = 0.65）、LGE患病率（比值比[OR] 1.2；95% CI 0.4至3.3；p = 0.72），以及一个合并的二元高等级或低等级纤维化参数（OR 1.1；95% CI 0.3至4.0；p = 0.94）。结论 重度无症状AS患者心肌纤维化标志物的严重程度与重度有症状AS患者相似，这表明在症状出现之前心肌就已受到实质性损伤。
