Aortic valve replacement in aortic stenosis reduced left ventricular mass index by 19% (P<0.0001) and diffuse fibrosis by 11% (P=0.003), but midwall late gadolinium enhancement did not change.
Cohort (n=99)
Does aortic valve replacement reverse left ventricular hypertrophy and myocardial fibrosis in patients with symptomatic aortic stenosis?
Cellular hypertrophy and diffuse fibrosis are reversible after aortic valve replacement, but replacement fibrosis (midwall LGE) is irreversible, suggesting early intervention may be beneficial once LGE is identified.
Background: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. We investigated the natural history of these processes in asymptomatic patients and their potential reversal post-aortic valve replacement (AVR). Methods: Asymptomatic and symptomatic patients with aortic stenosis underwent repeat echocardiography and magnetic resonance imaging. Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis (indexed extracellular volume), and replacement fibrosis (late gadolinium enhancement LGE) were quantified. RESULTS: In 61 asymptomatic patients (43% mild, 34% moderate, and 23% severe aortic stenosis), significant increases in peak aortic-jet velocity, left ventricular mass index, indexed extracellular volume, and LGE mass were observed after 2.1±0.7 years, with the most rapid progression observed in patients with most severe stenosis. Patients with baseline midwall LGE (n=16 26%; LGE mass, 2.5 g 0.8–4.8 g) demonstrated particularly rapid increases in scar burden (78% 50%–158% increase in LGE mass per year). In 38 symptomatic patients (age, 66±8 years; 76% men) who underwent AVR, there was a 19% (11%–25%) reduction in left ventricular mass index ( P <0.0001) and an 11% (4%–16%) reduction in indexed extracellular volume ( P =0.003) 0.9±0.3 years after surgery. By contrast midwall LGE (n=10 26%; mass, 3.3 g 2.6–8.0 g) did not change post-AVR (n=10; 3.5 g 2.1–8.0 g; P =0.23), with no evidence of regression even out to 2 years. Conclusions: In patients with aortic stenosis, cellular hypertrophy and diffuse fibrosis progress in a rapid and balanced manner but are reversible after AVR. Once established, midwall LGE also accumulates rapidly but is irreversible post valve replacement. Given its adverse long-term prognosis, prompt AVR when midwall LGE is first identified may improve clinical outcomes. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01755936 and NCT01679431.
Everett et al. (Fri,) conducted a cohort in Aortic stenosis (n=99). Aortic valve replacement (AVR) was evaluated on Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis, and replacement fibrosis (LGE). Aortic valve replacement in aortic stenosis reduced left ventricular mass index by 19% (P<0.0001) and diffuse fibrosis by 11% (P=0.003), but midwall late gadolinium enhancement did not change.