Extracellular Myocardial Volume in Patients With Aortic Stenosis.
Everett RJ., Treibel TA., Fukui M., Lee H., Rigolli M., Singh A., Bijsterveld P., Tastet L., Musa TA., Dobson L., Chin C., Captur G., Om SY., Wiesemann S., Ferreira VM., Piechnik SK., Schulz-Menger J., Schelbert EB., Clavel M-A., Newby DE., Myerson SG., Pibarot P., Lee S., Cavalcante JL., Lee S-P., McCann GP., Greenwood JP., Moon JC., Dweck MR.
BACKGROUND: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis. OBJECTIVES: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes. METHODS: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery-based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters. RESULTS: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p