Key result
Six months after aortic valve replacement, post-contrast T1 values significantly decreased from 460 ms to 443 ms, suggesting that left ventricular hypertrophy regression is more cellular than interstitial.
Why the study?
Does aortic valve replacement alter myocardial cellular and interstitial remodeling measured by CMR T1 mapping in patients with severe aortic stenosis?
Observational (n=37)
Does aortic valve replacement alter myocardial cellular and interstitial remodeling measured by CMR T1 mapping in patients with severe aortic stenosis?
Aortic valve replacement leads to a decrease in ICV and an increase in ECV, suggesting that left ventricular hypertrophy regression is primarily driven by cellular regression rather than interstitial fibrosis regression.
Supports cellular-dominant LVH regression post-AVR; hypothesis-generating for T1 mapping in aortic stenosis and requires prospective validation.
the aim of the study was to assess T1 mapping using T1 values, extracellular volume (ECV) and intra cellular volume (ICV) with cardiovascular magnetic resonance (CMR) in patients with surgical aortic stenosis before and after surgery. A prospective CMR T1 mapping study of 37 patients with severe AS before and six months after aortic valve replacement (AVR) was conducted. CMR at 1.5 T, including T1 mapping using a modified Look-Locker inversion recovery sequence (before and 15 minutes after the administration of 0.2 mmol/kg of Gadoteric acid), was carried out. Global T1 values, ECV, ICV have been measured before and six months after surgery. After AVR, post contrast T1 values were significantly lower compared to before surgery (443 ± 18 ms versus 460 ± 19 ms; p=0,027). ECV was significantly higher after surgery (27,9 ± 4,7 % versus 25,1 ± 2,7 %; p = 0.0001). Reciprocally, ICV significantly decreased after surgery (74,9 % versus 72,1 % p = 0.0001). In parallel, myocardial mass (89.5 ± 27 g/m2 versus 74.5 ± 23 g/m2 ; p<0,001), end diastolic volume (74 ± 19 ml/m2 versus 65 ± 12 ml/m2 ; p<0,001) and septal thickness (15 ± 2.5 mm versus 14 ± 2.5 mm ; p<0,001) decreased significantly after surgery. Post contrast T1 values, ICV, myocardial mass and septal thickness significantly decreased after AVR, suggesting that LV hypertrophy regression is more cellular than interstitial fibrosis regression. Larger studies are needed to confirm these data.
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Vermès et al. (2015) conducted an observational in Severe aortic stenosis (n=37). Aortic valve replacement vs. Before surgery (baseline) was evaluated on Post contrast T1 values (p=0.027). Six months after aortic valve replacement, post-contrast T1 values significantly decreased from 460 ms to 443 ms, suggesting that left ventricular hypertrophy regression is more cellular than interstitial.
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