Valvular & structural heart diseaseResearch article
Impact of the Extent, Pattern, and Location of Replacement Myocardial Fibrosis on Clinical Outcomes in Aortic Regurgitation
- consecutive patients with moderate-to-severe aortic regurgitation (AR) and no significant coronary artery stenosis who underwent contrast-enhanced cardiac magnetic resonance (CMR) were included
- Between 2010 and 2024
Authors' conclusion
In AR, an LGE extent > 2.6% predicts MACE better than LGE presence alone. Furthermore, non-ischemic predominant subendocardial-involved LGE is independently associated with MACE. The coexistence of both features further amplifies the risk of MACE.
Study context
- Population
- Patients with chronic moderate-to-severe aortic regurgitation (AR) and no significant coronary artery stenosis who underwent contrast-enhanced cardiac magnetic resonance (CMR)mean age 52.6 ± 14.2 years, 54 female
- Participants
- 363 patients
- Comparison
- The association between late gadolinium enhancement (LGE) characteristics and major adverse cardiovascular events (MACE)
- LGE presentn = 200
- Outcome
- Major adverse cardiovascular events (MACE): cardiovascular mortality, heart transplantation, or rehospitalization for heart failure
- Follow-up
- Median 56.6 months
Main finding
As reported in the abstract
Hazard ratio
3.028
95% CI 1.216–7.539
P = 0.017
Predominant subendocardial-involved LGE
HR 3.028 (95% CI 1.216–7.539); P = 0.017
- Patients who experienced MACE
- 73
Further findings
LGE presence
- LGE was present
- 200 patients (55.1%)
LGE extent threshold of 2.6% for risk stratification
- C-index (highest)
- 0.797
- Likelihood ratio chi-square
- 97.30
- Akaike information criterion (lowest)
- 681.06
Predominant subendocardial-involved LGE among LGE-positive patients
- Predominant subendocardial-involved LGE, of LGE-positive patients
- 13.5%
MACE by combined LGE extent and pattern (Kaplan-Meier)
- Patients with both LGE extent >2.6% and predominant subendocardial-involved LGE pattern were at the highest risk of MACE
Original publication
Impact of the Extent, Pattern, and Location of Replacement Myocardial Fibrosis on Clinical Outcomes in Aortic Regurgitation. Eur Heart J Cardiovasc Imaging. Published 14 October 2026. doi:10.1093/ehjci/jeag285
Summarised from the published abstract; every number is checked against it