Valvular & structural heart diseaseCohort study
Myocardial Fibrosis and Reverse Remodeling After Valve Replacement in Chronic Aortic Regurgitation
- Prospective longitudinal observational study
- 2 tertiary cardiothoracic centres, London, UK
Authors' conclusion
In this study, AVR was associated with substantial reverse remodeling at 7 months, including regression of hypertrophy and a fall in indexed extracellular (matrix) volume; the extracellular volume fraction rose, as cellular regression outpaced matrix regression. Focal scar, as a proportion of myocardium, was unchanged. Preoperative focal scar was independently associated with less recovery and may mark incomplete remodeling. Objective functional recovery did not improve at this time point.
Study context
- Population
- Patients with chronic severe aortic regurgitation referred for aortic valve replacement (AVR)completed paired studies
- Participants
- 72 patients
- Exposure
- Before vs after AVR
- Outcome
- LV reverse remodeling (change in LVEDV and LV mass) post-AVR and preoperative correlates of incomplete recovery, with prespecified focus on CMR fibrosis markers (LGE and ECV)
- Follow-up
- Median 7 months after AVR
Main finding
As reported in the abstract
Median LVEDV fell 44%, from 273 (IQR 211-307) mL to 153 (IQR 130-177) mL
P < .001
Median left ventricular (LV) mass fell 21%, from 200 (IQR 159-226) g to 158 (IQR 137-184) g
P < .001
Baseline LGE burden associated with less regression of LV mass (χ22 = 29.4)
P < .001
Baseline LGE burden associated with less regression of LVEDV at 7 months (χ21 = 7.9)
P = .007
Observational data: associations, not effects.
Further findings
Regurgitant volume
- Median fell from 61 (IQR 38-83) mL to 5 (IQR 3-8) mL
- P < 0.001
Myocardial tissue volumes (cardiovascular magnetic resonance (CMR))
- Indexed extracellular volume declined 15% (26 mL/m² to 22 mL/m²)
- P < 0.001
- ECV% rose from 27.4% to 29.1%
- P < 0.001
- LGE as % of LV mass unchanged (2.3% to 2.4%)
- P = 0.36
- Indexed intracellular volume declined 21%
Symptoms and function
- NYHA class and quality of life improved; median EQ-5D index 0.89 (IQR 0.78-1.00) to 0.94 (IQR 0.81-1.00)
- P < 0.001
- Maximum oxygen consumption unchanged (22.6 mL/kg/min to 21 mL/kg/min)
- P = 0.08
NT-proBNP
- Decreased slightly (228 pg/mL to 198 pg/mL)
- P = 0.27
- Patients with evidence of decompensation (n = 31): 469 pg/mL to 279 pg/mL
- P = 0.02
Original publication
Summarised from the published abstract; every number is checked against it