Abstract 16762: Post-Operative Prognostic Prediction of Different Myocardial Fibrosis Measures in Severe Aortic Valvular Heart Disease

• Published in: Circulation (New York, N.Y.) Vol. 142; no. Suppl_3 Suppl 3; p. A16762
• Main Authors: Pires, Lucas J, Rosa, Vitor E, MORAIS, THAMARA C, de Santis, Antonio S, Fernandes, Joao Ricardo C, boer, berta p, rossi, eduardo, Lavitola, Paulo d, Rochitte, Carlos E, Nomura, Cesar H, Pomerantzeff, Pablo M, Tarasoutchi, Flavio
• Format: Journal Article
• Language: English
• Published: by the American College of Cardiology Foundation and the American Heart Association, Inc 17.11.2020
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.16762

IntroductionAortic stenosis (AS) and aortic regurgitation (AR) patients develop myocardial remodeling characterized by hypertrophia and fibrosis. Cardiac magnetic resonance (CMR) imaging can detect the presence of replacement myocardial fibrosis, by using late gadolinium enhancement (LGE), and diffuse myocardial fibrosis, by using extracellular volume (ECV) based measures (relative - ECV fraction - and absolute - indexed ECV) calculated from T1 mapping. There are only few studies with AS patients and scarce data with AR patients showing an association between fibrosis and post-operative clinical outcomes. HypothesisThere is an association between preoperative myocardial fibrosis measures and post-operative clinical outcomes in severe aortic valvular heart disease (VHD) patients submitted to surgical intervention. MethodsPatients with isolated severe AS or AR were prospectively recruited to be submitted to CMR before indicated surgery, including LGE and ECV measures quantifications. All patients were submitted to conventional surgery and were followed during post-operative period. ResultsThe study population included 99 patients, 67 with AS and 32 with AR. After a median post-operative follow up of 12.3 (3.2-24.4) months, the presence of LGE areas, found in 32 patients (32.3%), independently predicted post-operative combined events (global mortality or STS morbidity events or persistent NYHA functional class III-IV) during follow up in univariate and multivariate Cox regression analyses (HR 3.96, 95%CI 1.76-8.91, p<0.01). Kaplan-Meier curve is presented in Figure 1. ECV fraction (HR 1.02, 95%CI 0.96-1.09, p=0.55) or indexed ECV (HR 1.00, 95%CI 0.97-1.03, p=0.86) did not predict post-operative combined events. ConclusionsPresence of replacement myocardial fibrosis, but not diffuse myocardial fibrosis, in preoperative CMR predicts post-operative combined clinical events in severe VHD patients submitted to surgery.