Midwall Fibrosis Is an Independent Predictor of Mortality in Patients With Aortic Stenosis

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• 作者：Marc R.  ; Dweck MD^?/sup> ; &#xA0 ; ^&dagger ; ; Sanjiv  ; Joshi MD^?/sup> ; Timothy&#xA0 ; Murigu BSc^?/sup> ; Francisco  ; Alpendurada MD^?/sup> ; Andrew  ; Jabbour MD^?/sup> ; Giovanni  ; Melina MD^?/sup> ; Winston&#xA0 ; Banya MSc^?/sup> ; Ankur  ; Gulati MD^?/sup> ; &#xA0 ; ^&Dagger ; ; Isabelle  ; Roussin MD^?/sup> ; Sadaf  ; Raza^?/sup> ; Nishant A.  ; Prasad^?/sup> ; Rick&#xA0 ; Wage BSc^?/sup> ; Cesare  ; Quarto MD^?/sup> ; Emiliano  ; Angeloni MD^?/sup> ; Simone&#xA0 ; Refice MD^?/sup> ; Mary  ; Sheppard MD^?/sup> ; Stuart A.  ; Cook MD ; PhD^?/sup> ; Philip J.&#xA0 ; Kilner MD ; PhD^?/sup> ; &#xA0 ; ^&Dagger ; ; Dudley J.&#xA0 ; Pennell MD^?/sup> ; &#xA0 ; ^&Dagger ; ; David E.  ; Newby MD ; DSc^&dagger ; ; Raad H.  ; Mohiaddin MD^?/sup> ; &#xA0 ; ^&Dagger ; ; John&#xA0 ; Pepper MD^?/sup> ; Sanjay K.  ; Prasad MD^?/sup> ; &#xA0 ; ^&Dagger ; ; &#xA0 ; ^{s.prasad@rbht.nhs.uk}
• 关键词：aortic valve stenosis ; gadolinium ; mortality ; myocardial fibrosis ; myocardial infarction
• 刊名：Journal of the American College of Cardiology
• 出版年：2011
• 出版时间：13 September 2011
• 年：2011
• 卷：58
• 期：12
• 页码：1271-1279
• 全文大小：994 K

文摘

ass=""h4"">Objectives

The goal of this study was to assess the prognostic significance of midwall and infarct patterns of late gadolinium enhancement (LGE) in aortic stenosis.

ass=""h4"">Background

Myocardial fibrosis occurs in aortic stenosis as part of the hypertrophic response. It can be detected by LGE, which is associated with an adverse prognosis in a range of other cardiac conditions.

ass=""h4"">Methods

Between January 2003 and October 2008, consecutive patients with moderate or severe aortic stenosis undergoing cardiovascular magnetic resonance with administration of gadolinium contrast were enrolled into a registry. Patients were categorized into absent, midwall, or infarct patterns of LGE by blinded independent observers. Patient follow-up was completed using patient questionnaires, source record data, and the National Strategic Tracing Service.

ass=""h4"">Results

A total of 143 patients (age 68 ¡À 14 years; 97 male) were followed up for 2.0 ¡À 1.4 years. Seventy-two underwent aortic valve replacement, and 27 died (24 cardiac, 3 sudden cardiac deaths). Compared with those with no LGE (n = 49), univariate analysis revealed that patients with midwall fibrosis (n = 54) had an 8-fold increase in all-cause mortality despite similar aortic stenosis severity and coronary artery disease burden. Patients with an infarct pattern (n = 40) had a 6-fold increase. Midwall fibrosis (hazard ratio: 5.35; 95 % confidence interval: 1.16 to 24.56; p = 0.03) and ejection fraction (hazard ratio: 0.96; 95 % confidence interval: 0.94 to 0.99; p = 0.01) were independent predictors of all-cause mortality by multivariate analysis.

ass=""h4"">Conclusions

Midwall fibrosis was an independent predictor of mortality in patients with moderate and severe aortic stenosis. It has incremental prognostic value to ejection fraction and may provide a useful method of risk stratification. (The Prognostic Significance of Fibrosis Detection in Cardiomyopathy; )