Key result
Myocardial fibrosis affects ~53% of asymptomatic severe AS patients with no difference across classification subtypes.
Why the study?
To assess whether traditional aortic stenosis classification correlates with myocardial fibrosis evaluated by CMR in asymptomatic severe AS, and to identify echocardiographic parameters associated with fibrosis.
Observational (n=76)
Myocardial fibrosis is present in half of asymptomatic severe AS patients regardless of traditional AS subtype, and is associated with LV hypertrophy and LA remodeling on echocardiography.
Myocardial fibrosis assessment may be needed beyond hemodynamic subtypes in asymptomatic severe AS; leaves open whether CMR refines risk stratification.
Aims To assess whether traditional aortic stenosis (AS) classification correlates with myocardial fibrosis as evaluated by cardiac magnetic resonance (CMR) in asymptomatic severe AS and to identify echocardiographic parameters associated with myocardial fibrosis. Methods and results A prospective observational study on asymptomatic patients with severe AS (aortic valve area <1.0 cm², LVEF ≥50%) who underwent transthoracic echocardiography (TTE) and CMR was conducted. Patients were classified into high-gradient (HG), low-flow low-gradient (LFLG), and normal-flow low-gradient (NFLG) AS subtypes. Myocardial fibrosis was assessed by CMR using late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV). Among 76 patients, LGE was present in 40 (53%), with a median extent of 1.24% (0.41–3.75%;) and a median ECV of 26.9%. No significant differences in myocardial fibrosis were found across all AS subtypes. Patients with LGE exhibited higher left ventricular mass (114.2 vs. 98.5 g/m², P=0.033) and greater wall thickness (13.5 vs 12.0 mm, P=0.026), as well as an increased left atrial volume index (LAVI, 45.4 vs. 35.2 mL/m², P=0.011) on TTE. A significant non-linear association between LAVI and LGE presence was observed. Myocardial fibrosis correlated with extravalvular cardiac damage. Conclusion Myocardial fibrosis, as assessed by LGE, was observed in half of the patients with asymptomatic severe AS and preserved LVEF and did not differ across all AS subtypes. Left ventricular hypertrophy and left atrial remodelling by TTE were associated with myocardial fibrosis and could serve as surrogate markers of extravalvular cardiac damage. This finding highlights the limitations of traditional classification alone in predicting myocardial impairment.
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Galian-Gay et al. (2026) conducted an observational in Asymptomatic severe aortic stenosis (n=76). Traditional aortic stenosis classification (high-gradient, low-flow low-gradient, and normal-flow low-gradient) was evaluated on Myocardial fibrosis assessed by CMR (late gadolinium enhancement, native T1 mapping, and extracellular volume). Myocardial fibrosis was present in 53% of patients with asymptomatic severe aortic stenosis and preserved LVEF, with no significant differences across traditional AS subtypes.
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