Valvular & structural heart disease
Postoperative myocardial fibrosis assessment in aortic valvular heart diseases—a cardiovascular magnetic resonance study
Authors' conclusion
Patients with both AR or AS presented reduction in iECV after surgery, unfolding the reversible nature of diffuse MF. In contrast to patients with AS, those with AR developed postoperative iECV regression with stable ECV, suggesting a balanced reduction in both intracellular and extracellular myocardial components.
Study context
- Population
- Patients with severe aortic regurgitation (AR) or aortic stenosis (AS) and indications for surgeryanalysed
- Participants
- 99 patients
- Exposure
- Pre- vs postoperative cardiovascular magnetic resonance (CMR) in AR vs AS
- ARn = 32
- ASn = 67
- Outcome
- Postoperative changes in diffuse myocardial fibrosis (ECV and iECV on CMR)
Main finding
As reported in the abstract
iECV (pre- to postoperative)
| Group | Indexed extracellular volume (iECV) pre→post |
|---|---|
| AR | 30-26.5 mL/m² |
| AS | 22-18.2 mL/m² |
Indexed extracellular volume (iECV) pre→post
AR30-26.5 mL/m²
AS22-18.2 mL/m²
- AR vs AS: P < 0.001 — postoperative iECV 26.5 vs 18.2 mL/m²
- iECV decreased after surgery in both groups
- both P < 0.001
- Postoperative ECV, AR: 28.4% pre vs 29.9% post (stable)
- P = 0.617
- Postoperative ECV, AS: 27.2% pre vs 28.6% post (increased)
- P = 0.033
Observational data: associations, not effects.
Further findings
Preoperative iECV and ECV, AR vs AS
iECV AR 30 mL/m² · AS 22 mL/m² · P = 0.001
ECV
P = 0.048
| Outcome | AR | AS |
|---|---|---|
| LV mass index (pre vs post) | ||
| Pre vs post | 110 vs. 91 g/m² | 86 vs. 68 g/m² |
| LGE fraction and LGE mass (pre vs post) | ||
| LGE fraction | 1.9% vs 1.7%, P = 0.575 | 2.4% vs 2.4%, P = 0.615 |
| LGE mass | 3.8 g vs 2.5 g, P = 0.635 | 3.4 g vs 3.5 g, P = 0.575 |
- LV mass index (pre vs post) — LV mass index decreased in both groups
- both P < 0.001
LGE fraction and LGE mass (pre vs post)
- LGE remained stable in both groups
Original publication
Postoperative myocardial fibrosis assessment in aortic valvular heart diseases—a cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging. Published 20 March 2023. doi:10.
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