In severe aortic stenosis, a low gradient was associated with a higher degree of interstitial fibrosis, which inversely correlated with mitral ring displacement (r = -0.79, p < 0.0001).
Cohort (n=86)
Do echocardiographic surrogates of myocardial fibrosis, such as mitral ring displacement, correlate with histological fibrosis and help differentiate low-gradient severe aortic stenosis from moderate aortic stenosis?
In patients with severe aortic stenosis, a low gradient is associated with advanced myocardial fibrosis and poorer clinical outcomes despite preserved ejection fraction, and mitral ring displacement can serve as a useful surrogate to differentiate this high-risk phenotype from moderate aortic stenosis.
Effect estimate: r = -0.79
p-value: p=<0.0001
OBJECTIVES: This prospective cohort study in patients with aortic stenosis (AS) aimed to identify surrogates of myocardial fibrosis that are easy to derive in clinical practice, allow the differentiation of low-gradient severe AS from moderate AS, and have an impact on clinical outcome. BACKGROUND: In patients with symptomatic aortic AS, a characteristic subgroup (i.e., up to one-third) exhibits severe AS with a concomitant low mean valve gradient either with preserved or reduced ejection fraction (EF). It is hypothesized that these patients tend to have an advanced stage of myocardial fibrosis and poor clinical outcome. METHODS: Eighty-six patients with moderate or severe AS were examined by echocardiography including conventional aortic valve assessment, mitral ring displacement, and strain-rate imaging. Replacement fibrosis was quantified by late-enhancement magnetic resonance imaging. Biopsy samples were taken from patients with severe AS (n = 69) at aortic valve replacement. All patients were followed for 9 months. RESULTS: Patients were divided into 4 groups according to aortic valve area (<1.0 cm(2)), mean valve gradient ≥40 mm Hg, and EF (<50%): group 1, moderate AS (n = 17); group 2, severe AS/high gradient (n = 49); group 3, severe AS/low gradient/preserved EF (n = 11); and group 4, severe AS/low gradient/decreased EF (n = 9). At baseline, a significant decrease in mitral ring displacement and systolic strain rate was detected in patients with low-gradient AS. In low-gradient groups, a higher degree of interstitial fibrosis in biopsy samples and more late-enhancement magnetic resonance imaging segments were observed. A close inverse correlation was found between interstitial fibrosis and mitral ring displacement (r = -0.79, p < 0.0001). Clinical outcome was best for patients in group 1, whereas mortality risk increased substantially in groups 2 through 4. CONCLUSIONS: In severe AS, a low gradient is associated with a higher degree of fibrosis, decreased longitudinal function, and poorer clinical outcome despite preserved EF. Mitral ring displacement differentiates between moderate AS and low-gradient/severe AS with preserved EF.
Herrmann et al. (Fri,) conducted a cohort in Aortic stenosis (n=86). Low-gradient severe aortic stenosis vs. Moderate aortic stenosis and high-gradient severe aortic stenosis was evaluated on Correlation between interstitial fibrosis and mitral ring displacement (r = -0.79, p=<0.0001). In severe aortic stenosis, a low gradient was associated with a higher degree of interstitial fibrosis, which inversely correlated with mitral ring displacement (r = -0.79, p < 0.0001).
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