이현정 (서울대학교병원)

한빛사논문

조회233

서울대학교병원

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JACC-Cardiovasc. Imag., Sep 10 2024, S1936-878X(24)00343-7 | https://doi.org/10.1016/j.jcmg.2024.08.003 Diffuse Interstitial Fibrosis of the Myocardium Predicts Outcome in Moderate and Asymptomatic Severe Aortic Stenosis

Hyun-Jung Lee MD, PhD ^a,b, Anvesha Singh MBChB, PhD^c, Jaehyun Lim MD ^a, Neil Craig MD ^d, Rong Bing MD ^d, Lionel Tastet PhD ^e, Jun-Bean Park MD, PhD^a,f, Hyung-Kwan Kim MD, PhD ^a,f, Yong-Jin Kim MD, PhD^a,f, Marie-Annick Clavel DVM, PhD ^e, Bernhard L. Gerber MD, PhD ^g, Gerry P. McCann MBChB, MD ^c, Marc R. Dweck MD, PhD ^d, Phillipe Pibarot DVM, PhD ^e, Seung-Pyo Lee MD, PhD ^a,f

^aDivision of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

^bDivision of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

^cDepartment of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenﬁeld Hospital, Leicester, United Kingdom

^dCentre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, United Kingdom

^eInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada

^fDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

^gDivision of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Institut de Recherche Cardiovasculaire, Université Catholique de Louvain, Brussels, Belgium

Address for correspondence: Dr Seung-Pyo Lee

Abstract

Background

Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events.

Objectives

The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS.

Methods

A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm2) or asymptomatic severe AS (AVA ≤1.0 cm2 and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission.

Results

Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05).

Conclusions

Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.

논문정보

형식Research article
게재일2024년 09월 (BRIC 등록일 2024-09-30)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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