Differences in Aortic Valve and Left Ventricular Parameters Related to the Severity of Myocardial Fibrosis in Patients with Severe Aortic Valve Stenosis

<div><p>Objective</p><p>This study investigated the morphological and functional characteristics of the aortic valve and the left ventricular (LV) systolic functional parameters and myocardial mass related to the severity of myocardial fibrosis (MF) in patients with severe aortic valve stenosis (AS).</p><p>Materials and Methods</p><p>We retrospectively enrolled 81 patients (48 men; mean age: 59±12 years) with severe AS who underwent transthoracic echocardiography (TTE), cardiac computed tomography (CCT), and cardiovascular magnetic resonance (CMR) within 1 month and subsequent aortic valve surgery. Degree of MF was determined on delayed contrast-enhanced CMR with visual sub-segmental analysis-based quantification and was classified into three groups (no, mild, and severe) for identifying the differences in LV function and characteristics of the aortic valve. One-way ANOVA, Chi-square test or Fisher’s exact test were used to compare variables of the three groups. Univariate multinomial logistic regression analysis was performed to determine the association between the severity of MF and variables on imaging modalities.</p><p>Results</p><p>Of 81 patients, 34 (42%) had MF (mild, n = 18; severe, n = 16). Aortic valve calcium volume score on CCT, aortic valve area, LV mass index, LV end-diastolic volume index on CMR, presence of mild aortic regurgitation (AR), transaortic mean pressure gradient, and peak velocity on TTE were significantly different among the three groups and were associated with severity of MF on a univariate multinomial logistic regression analysis. Aortic valve calcium grade was different (<i>p</i> = 0.008) among the three groups but not associated with severity of MF (<i>p</i> = 0.375).</p><p>Conclusions</p><p>A multi-imaging approach shows that severe AS with MF is significantly associated with more severe calcific AS, higher LV end-diastolic volume, higher LV mass, and higher prevalence of mild AR.</p></div

Example of sub-segmental scoring model used for visual coding of focal myocardial fibrosis location.

<p><b>a</b> Cardiac magnetic resonance demonstrated extensive delayed contrast enhancement in mid-ventricular short axis image. <b>b</b> Mid-ventricular segments are divided into four transmural zones and coded according to transmural extent of delayed contrast enhancement.</p

Odds ratio for imaging variables for the severity of myocardial fibrosis on univariate multinomial logistic regression analysis.

<p>Odds ratio for imaging variables for the severity of myocardial fibrosis on univariate multinomial logistic regression analysis.</p

Images of variable patterns of delayed contrast enhancement on myocardium.

<p><b>a</b> No delayed contrast enhancement on myocardium is defined as the absence of myocardial fibrosis. The patterns of myocardial fibrosis are diffuse (arrow, <b>b</b>), patchy (arrow, <b>c</b>), nodular (arrow, <b>d</b>), or linear (arrow, <b>e</b>).</p

Differences of multimodality imaging findings according to the severity of MF.

<p>Differences of multimodality imaging findings according to the severity of MF.</p

Clinical characteristics of patients with severe aortic valve stenosis (n = 81) according to the severity of myocardial fibrosis.

<p>Clinical characteristics of patients with severe aortic valve stenosis (n = 81) according to the severity of myocardial fibrosis.</p

Supplemental material for Association between aortic valvular calcification and characteristics of the aortic valve in patients with bicuspid aortic valve stenosis

<p>Supplemental material for Association between aortic valvular calcification and characteristics of the aortic valve in patients with bicuspid aortic valve stenosis by Bo Hwa Choi, Sung Min Ko, Je Kyoun Shin, Hyun Keun Chee, Jun Seok Kim and Jayoun Kim in Acta Radiologica</p