Myocardial Scar and Mortality in Severe Aortic Stenosis

Figure 1.. Multi modality assessment of aortic stenosis (AS). Assessment of AS by transthoracic echocardiography (TTE; A–C) and cardiovascular magnetic resonance (D–F). A, Continuous Doppler trace across the aortic valve in the apical 5-chamber demonstrating hemodynamic parameters consistent with severe AS (peak velocity, 4.67 m/s; peak gradient, 87 mm Hg; mean gradient, 51 mm Hg). B, Short-axis TTE image of a severely calcified aortic valve. C, Parasternal long-axis image demonstrating left ventricular hypertrophy (#) and a calcified aortic valve (*). D, Four-chamber balanced steady-state free precession cine image demonstrating left ventricular hypertrophy; white dotted line demonstrates the axis of acquisition of the short axis (E and F). E, Late gadolinium enhancement (LGE) image in a midventricular short axis showing transmural LGE of a full-thickness myocardial infarct (arrow). F, LGE image in a midventricular short axis showing patchy nonischemia LGE in the mid inferolateral segment (arrow) and more subtle LGE in the inferoseptum and right ventricular insertion points.

Figure 2.. All-cause and cardiovascular mortality in severe aortic stenosis by late gadolinium enhancement (LGE) status. Kaplan-Meier (KM) survival plots showing all-cause (left) and cardiovascular (CV; right) mortality in all patients (A and B; n=674), patients treated with surgical aortic valve replacement (SAVR; C and D; n=399), and patients treated with transcatheter aortic valve replacement (TAVR; E and F; n=275), according to the presence or absence of LGE preoperatively. TAVI indicates transcatheter aortic valve implantation.

Figure 3.. All-cause mortality in severe aortic stenosis (AS) by late gadolinium enhancement (LGE) pattern. Kaplan-Meier (KM) survival plot showing all-cause mortality in all patients with severe AS (n=674) by pattern of late gadolinium enhancement (no LGE, infarct LGE, noninfarct LGE; both P<0.001). The plot summarizes 6-year follow-up data.