Increased extracellular volume fraction (ECV%) was independently associated with all-cause mortality in severe aortic stenosis (HR per percent increase 1.10; 95% CI 1.02-1.19; p=0.013).
Cohort (n=440)
Yes
Does increased extracellular volume fraction (ECV%) measured by CMR predict mortality in patients with severe aortic stenosis undergoing aortic valve intervention?
In patients with severe aortic stenosis, increased myocardial extracellular volume fraction (ECV%) measured by CMR is an independent predictor of all-cause mortality following aortic valve intervention.
Effect estimate: HR 1.10 (95% CI 1.02 to 1.19)
p-value: p=0.013
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 < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval 1.02 to 1.19; p = 0.013). CONCLUSIONS: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.
Everett et al. (Wed,) conducted a cohort in severe aortic stenosis (n=440). Extracellular volume fraction (ECV%) was evaluated on all-cause mortality (HR 1.10, 95% CI 1.02 to 1.19, p=0.013). Increased extracellular volume fraction (ECV%) was independently associated with all-cause mortality in severe aortic stenosis (HR per percent increase 1.10; 95% CI 1.02-1.19; p=0.013).