Key result
A higher mid-wall fibrosis risk score (≥52) was associated with a decreased probability of left ventricular reverse remodelling at one year after TAVR (OR 0.33; 95% CI 0.23-0.87; p=0.03).
Why the study?
The relevance of myocardial fibrosis assessed by the mid-wall fibrosis risk score with respect to left ventricular reverse remodelling following TAVR was unknown.
Does a higher mid-wall fibrosis risk (MFR) score predict reduced left ventricular reverse remodelling in patients undergoing TAVR?
Cohort (n=207)
Does a higher mid-wall fibrosis risk (MFR) score predict reduced left ventricular reverse remodelling in patients undergoing TAVR?
A higher mid-wall fibrosis risk score predicts reduced left ventricular reverse remodelling at 1 year after TAVR, but does not correlate with long-term mortality.
May aid risk stratification for LV remodelling after TAVR; hypothesis-generating and requires validation before clinical adoption.
AIMS: We sought to investigate the relevance of myocardial fibrosis, assessed by mid-wall fibrosis risk (MFR) score, with respect to left ventricular (LV) reverse remodelling following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: Between January 2010 and March 2015, we enrolled 207 patients in whom baseline MFR, which includes age, sex, high-sensitivity cardiac troponin I, presence of strain pattern on electrocardiography, and peak aortic valve velocity, as well as one-year follow-up echocardiography was available. LV reverse remodelling was defined as a >10% reduction in LV end-diastolic volume index (LVEDVi). A higher MFR score (≥52) was associated with increased LVEDVi and with decreased LV ejection fraction as well as higher baseline NT-proBNP levels (p<0.05 for all). One year after the TAVR procedure, a higher MFR score was associated with a decreased probability of LV reverse remodelling (OR 0.33, 95% CI: 0.23-0.87; p=0.03), which was independent of baseline echocardiographic parameters and comorbidities. In contrast, there was no significant difference in five-year mortality between patients with lower and higher MFR scores (57.9% vs 60.5%, p=0.66). CONCLUSIONS: A higher MFR score is associated with reduced LV reverse remodelling at one-year follow-up, whereas the MFR score does not appear to correlate with long-term mortality after TAVR.
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Sugiura et al. (2020) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=207). Higher mid-wall fibrosis risk (MFR) score (≥52) vs. Lower MFR score was evaluated on Left ventricular reverse remodelling (>10% reduction in LV end-diastolic volume index) (OR 0.33, 95% CI 0.23-0.87, p=0.03). A higher mid-wall fibrosis risk score (≥52) was associated with a decreased probability of left ventricular reverse remodelling at one year after TAVR (OR 0.33; 95% CI 0.23-0.87; p=0.03).
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