JACC: Cardiovascular Imaging
Myocardial Fibrosis and Cardiac Decompensation in Aortic Stenosis
Calvin W.L. Chin, Russell J. Everett, Jacek Kwiecinski, Alex T. Vesey, Emily Yeung, Gavin Esson, William Jenkins, Maria Koo, Saeed Mirsadraee, Audrey C. White, Alan G. Japp, Sanjay K. Prasad, Scott Semple, David E. Newby and Marc R. Dweck
Table 4
Table 4
Characteristics of Patients Stratified According to iECV Thresholds and Presence of Mid-Wall Late Gadolinium Enhancement
| Normal Myocardium (n = 71) | Extracellular Expansion (n = 31) | Replacement Fibrosis (n = 37) | p Value | |
|---|---|---|---|---|
| Age, yrs | 70 (63−75) | 70 (63−75) | 71 (65−78) | 0.59 |
| Sex (male = 1) | 0.56 (0.44−0.68) | 0.81 (0.67−0.96) | 0.76 (0.62−0.90) | 0.023 |
| Hypertension | 48 (68) | 20 (65) | 22 (59) | 0.70 |
| Diabetes | 8 (11) | 7 (23) | 2 (5) | 0.09 |
| Body mass index, kg/m2 | 28.2 ± 4.5 | 28.9 ± 4.6 | 29.3 ± 4.3 | 0.44 |
| Echocardiography | ||||
| Peak aortic jet velocity, m/s | 3.53 ± 0.82 | 3.79 ± 1.0 | 4.23 ± 0.92 | <0.001 |
| Aortic valve area, cm2 | 0.98 (0.73−1.18) | 0.88 (1.2−0.7) | 0.83 (0.73−0.91) | 0.049 |
| Mean AV pressure gradient, mm Hg | 29.1 ± 14.2 | 34.8 ± 21.1 | 41.1 ± 23.5 | 0.007 |
| Mild AS | 24 | 7 | 2 | |
| Moderate AS | 18 | 10 | 11 | |
| Severe AS | 29 | 14 | 24 | |
| Valvulo-arterial impedance, mm Hg/ml/m2 | 4.1 ± 1.0 | 3.9 ± 0.9 | 4.0 ± 1.0 | 0.46 |
| Mean e', cm/s | 6.7 ± 2.0 | 6.5 ± 1.8 | 5.2 ± 1.4 | 0.0004 |
| Mean E/e' ratio | 13.1 ± 7.7 | 13.2 ± 4.8 | 16.5 ± 6.5 | 0.04 |
| Mean diastolic dysfunction grade | 1.5 ± 0.9 | 2.0 ± 0.9 | 2.7 ± 0.5 | <0.0001 |
| CMR | ||||
| LVMi, g/m2 | 73 ± 11 | 96 ± 11 | 107 ± 25 | <0.0001 |
| Relative wall thickness | 0.60 ± 0.12 | 0.61 ± 0.09 | 0.67 ± 0.11 | 0.018 |
| ECVi, ml/m2 | 18.3 ± 2.5 | 25.4 ± 3.1 | 30.4 ± 8.2 | <0.0001 |
| Ejection fraction, % | 68 (63−71) | 66 (64−71) | 67 (64−72) | 0.94 |
| Longitudinal systolic function, mm | 13.2 ± 2.6 | 12.5 ± 2.4 | 11.2 ± 3.1 | 0.002 |
| Indexed left atrial volume, ml/m2 | 31 ± 13 | 37 ± 11 | 38 ± 15 | 0.027 |
| Biomarkers | ||||
| Natural log (hs troponin I) | 1.43 ± 0.96 | 2.02 ± 0.93 | 2.60 ± 0.90 | <0.0001 |
| Natural log (BNP) | 2.95 ± 1.00 | 3.06 ± 0.96 | 3.41 ± 1.10 | 0.12 |
| Functional status | ||||
| 6-min walk test, m | 406 ± 74 | 385±95 | 359 ± 138 | 0.08 |
| NYHA functional class | ||||
| I | 33 (46) | 18 (58) | 17 (46) | |
| II | 27 (38) | 6 (19) | 12 (32) | |
| III | 11 (15) | 7 (23) | 5 (14) | |
| IV | 0 (0) | 0 (0) | 3 (8) | |
| Outcomes | ||||
| All-cause mortality | 2 | 4 | 8 | — |
| All-cause mortality rate (per 1,000 patient-yrs) | 8 | 36 | 71 | 0.009 |
| AS-related mortality, n | 0 | 4 | 6 | — |
| AS-related mortality rate (per 1,000 patient-yrs) | 0 | 36 | 52 | 0.0045 |
| Patients Undergoing Myocardial Biopsy | Normal Myocardium on CMR (n = 3) | Extracellular Expansion on CMR (n = 5) | Replacement Fibrosis on CMR (n = 3) | p Value |
|---|---|---|---|---|
| Histological fibrosis, % | 8.9 ± 4.0 | 12.4 ± 2.5 | 22.4 ± 4.9 | 0.004 |
| Aortic valve area, cm2 | 0.57 ± 0.10 | 0.94 ± 0.29 | 0.81 ± 0.44 | 0.29 |
| Peak aortic jet velocity, m/s | 4.6 (4.4−5.1) | 4.5 (4.0−5.9) | 4.9 (4.1−8.0) | 0.63 |
| LVMi, g/m2 | 76 ± 15 | 98 ± 4 | 162 ± 6 | <0.0001 |
| Native myocardial T1, ms | 1,189 ± 23 | 1,183 ± 16 | 1,277 ± 15 | 0.0002 |
| Post-contrast myocardial T1, ms | 676 ± 45 | 615 ± 24 | 672 ± 84 | 0.22 |
| Partition coefficient | 0.43 ± 0.05 | 0.47 ± 0.02 | 0.55 ± 0.02 | 0.008 |
| ECV fraction, % | 25.3 ± 3.1 | 27.3 ± 1.4 | 32.2 ± 1.9 | 0.019 |
| iECV, ml/m2 | 18.8 ± 1.9 | 25.6 ± 0.7 | 49.6 ± 4.8 | <0.0001 |
Values are median (interquartile range), n (%), or mean ± SD.
Abbreviations as in Tables 1, 2, and 3.
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