Short-term adverse remodeling progression in asymptomatic aortic stenosis

Singh, Anvesha, Chan, Daniel CS, Kanagala, Prathap ORCID: 0000-0001-6739-5607, Hogrefe, Kai, Kelly, Damian J, Khoo, Jeffery P, Sprigings, David, Greenwood, John P, Abdelaty, Ahmed MSEK, Jerosch-Herold, Michael
et al (show 2 more authors) (2021) Short-term adverse remodeling progression in asymptomatic aortic stenosis. EUROPEAN RADIOLOGY, 31 (6). pp. 3923-3930.

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<h4>Objectives</h4>Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS.<h4>Methods</h4>Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI.<h4>Results</h4>Forty-three participants with moderate-severe AS (mean age 64.4 ± 14.8 years, 83.4% male, aortic valve area index 0.54 ± 0.15 cm<sup>2</sup>/m<sup>2</sup>) were included. There was small but significant increase in indexed left ventricular (LV) (90.7 ± 22.0 to 94.5 ± 23.1 ml/m<sup>2</sup>, p = 0.007) and left atrial volumes (52.9 ± 11.3 to 58.6 ± 13.6 ml/m<sup>2</sup>, p < 0.001), with a decrease in systolic (LV ejection fraction 57.9 ± 4.6 to 55.6 ± 4.1%, p = 0.001) and diastolic (longitudinal diastolic strain rate 1.06 ± 0.2 to 0.99 ± 0.2 1/s, p = 0.026) function, but no overall change in LV mass or mass/volume. Late gadolinium enhancement increased (2.02 to 4.26 g, p < 0.001) but markers of diffuse interstitial fibrosis did not change significantly (extracellular volume index 12.9 [11.4, 17.0] ml/m<sup>2</sup> to 13.3 [11.1, 15.1] ml/m<sup>2</sup>, p = 0.689). There was also a significant increase in the levels of NT-proBNP (43.6 [13.45, 137.08] pg/ml to 53.4 [19.14, 202.20] pg/ml, p = 0.001).<h4>Conclusions</h4>There is progression in cardiac remodeling with increasing scar burden even in asymptomatic AS. Given the lack of reversibility of LGE post-AVR and its association with long-term mortality post-AVR, this suggests the potential need for earlier intervention, before the accumulation of LGE, to improve the long-term outcomes in AS.<h4>Key points</h4>• Current guidelines recommend waiting until symptom onset before valve replacement in severe AS. • MRI showed clear progression in cardiac remodeling over 12 months in asymptomatic patients with AS, with near doubling in LGE. • This highlights the need for potentially earlier intervention or better risk stratification in AS.

Item Type: Article
Uncontrolled Keywords: Aortic valve stenosis, Magnetic resonance imaging, Fibrosis
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Clinical Directorate
Depositing User: Symplectic Admin
Date Deposited: 10 Oct 2022 08:02
Last Modified: 18 Jan 2023 20:37
DOI: 10.1007/s00330-020-07462-9
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