Assessment of Myocardial Fibrosis Using Multimodality Imaging in Severe Aortic StenosisComparison With Histologic Fibrosis
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Author + information
- Sung-Ji Park, MD, PhDa,∗∗∗ (tyche.park{at}gmail.com),
- Sung Woo Cho, MD, PhDb,∗,
- Sung Mok Kim, MD, PhDc,∗ (sungmok_kim{at}hanmail.net),
- Joonghyun Ahn, MSd,
- Keumhee Carriere, PhDd,e,
- Dong Seop Jeong, MD, PhDf,
- Sang-Chol Lee, MD, PhDa,
- Seung Woo Park, MD, PhDa,
- Yeon Hyeon Choe, MD, PhDc,
- Pyo Won Park, MD, PhDf and
- Jae K. Oh, MDa,g
- aDepartment of Medicine, Division of Cardiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- bDepartment of Medicine, Division of Cardiology, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea
- cDepartment of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- dBiostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
- eDepartment of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada
- fDepartment of Thoracic Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- gDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
- ↵∗Addresses for correspondence:
Dr. Sung Mok Kim, Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea. - ↵∗∗Dr. Sung-Ji Park, Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
Graphical abstract
Abstract
Objectives This study assessed diffuse myocardial fibrosis (MF) by cardiac magnetic resonance (CMR) imaging and speckle-tracking echocardiography (STE) in patients with severe aortic stenosis (AS) and validated findings by using histologic confirmation of MF.
Background MF is a concomitant pathologic finding related to hypertrophic response in severe AS. It would be beneficial to have reliable imaging methods to assess MF.
Methods CMR and STE were performed in 71 consecutive patients with severe AS before aortic valve replacement. The extracellular volume (ECV) and native T1 values obtained by CMR and global longitudinal strain (GLS) values by STE were measured. The degree of MF was quantified by using Masson trichrome stain in myocardial biopsy specimens obtained intraoperatively. The study population was divided into 3 groups according to the degree of MF on histology (mild, moderate, and severe MF).
Results The severe MF group had a higher incidence of heart failure (HF) and diastolic dysfunction than the mild and moderate MF groups. The ECV (r = 0.465; p < 0.0001), GLS (r = 0.421; p = 0.0003), and native T1 (r = 0.429; p = 0.0002) values were significantly correlated with the degree of MF. GLS was moderately correlated with ECV (r = 0.455; p = 0.0001) and less with the native T1 (r = 0.372; p = 0.0014) value. The model using ECV (R2 = 0.44; Akaike Information Criterion [AIC] = 55.8) was found to predict the degree of MF most accurately than that with GLS (R2 = 0.35; AIC = 66.84) and the native T1 (R2 = 0.36; AIC = 66.18) value. The secondary endpoint of interest was clinical outcome of a composite of total mortality, admission for HF, or development of HF symptoms. During follow-up (median: 4.6 years), and there were 16 clinical events. Although statistically insignificant, ECV is more closely related to prediction of the clinical outcome than native T1 or GLS.
Conclusions ECV as assessed by CMR could be an ideal surrogate marker for diffuse MF in patients with severe AS among all 3 models considered.
Footnotes
↵∗ Drs. Park and Cho contributed equally to this work and are joint first authors.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 13, 2017.
- Revision received May 21, 2018.
- Accepted May 31, 2018.
- 2019 American College of Cardiology Foundation
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