Key result
Congenital aortic stenosis links to ~19% higher LV mass index and persistent myocardial fibrosis after AVR.
Why the study?
Data on structural left ventricular remodeling in congenital aortic stenosis are scarce, leaving remodeling patterns before and after aortic valve replacement and markers of myocardial fibrosis poorly described.
What are the CMR-derived structural LV remodeling and myocardial fibrosis characteristics in adults with congenital aortic valve stenosis compared to healthy controls?
Observational (n=73)
What are the CMR-derived structural LV remodeling and myocardial fibrosis characteristics in adults with congenital aortic valve stenosis compared to healthy controls?
Absolute Event Rate: 70% vs 59%
p-value: p=0.023
Adults with congenital aortic stenosis exhibit increased LV mass and a 26% prevalence of myocardial fibrosis (LGE) that persists even after aortic valve replacement.
Persistent remodeling and fibrosis after AVR in congenital AS; leaves open fibrosis markers for risk stratification in prospective studies.
Background Left ventricular (LV) remodeling is becoming increasingly important in assessing the impact of aortic stenosis (AS). However, data on structural LV remodeling in congenital AS patients is scarce. Therefore, this study aimed to describe LV remodeling before and after aortic valve replacement (AVR) in adults with congenital AS and identify markers associated with myocardial fibrosis. Methods and results In this prospective study, adult patients with congenital AS were included with 1) at least mild AS (Vmax ≥2.5 m/s) or 2) prior AVR due to congenital AS. Cardiovascular Magnetic Resonance (CMR) was performed to assess structural LV remodeling. Results were compared with CMR data from 20 healthy controls. Data from 73 patients were included (median age 43 [30–52] years, 67% male), of whom 20 patients were post-AVR. LV systolic function was preserved in all patients. LV mass index was significantly higher in patients with a native valve than in controls (70 ± 19 vs. 59 ± 8 g/m 2 , p = 0.023). Late gadolinium enhancement (LGE) was present in 19 patients (26%): 13 with a native valve and 6 post-AVR (25% vs. 30%, p = 0.64). Native T1 and extracellular volume (ECV) did not differ significantly from healthy controls. In patients post-AVR, LV mass index and matrix volume were significantly lower compared to patients with a native valve. Conclusion LGE was present in a quarter of adults with congenital AS. However, ECV in patients with native valves did not differ significantly from healthy controls. LV dimensions were lower in patients post-AVR, but LGE persisted, indicating LV remodeling even after AVR.
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Keuning et al. (2026) conducted an observational in Congenital aortic valve stenosis (n=73). Congenital aortic stenosis (native valve) vs. Healthy controls was evaluated on Left ventricular mass index (p=0.023). Adults with congenital aortic stenosis and a native valve had a significantly higher LV mass index compared to healthy controls (70 vs. 59 g/m2, p=0.023), with myocardial fibrosis persisting even after AVR.
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