Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2021
2021
Historique:
received:
01
11
2020
accepted:
23
02
2021
entrez:
10
3
2021
pubmed:
11
3
2021
medline:
13
10
2021
Statut:
epublish
Résumé
The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65-0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.
Sections du résumé
BACKGROUND
The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention.
METHODS
Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification.
RESULTS
Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65-0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted.
CONCLUSION
In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.
Identifiants
pubmed: 33690718
doi: 10.1371/journal.pone.0248306
pii: PONE-D-20-34373
pmc: PMC7946277
doi:
Substances chimiques
Blood Proteins
0
Galectins
0
LGALS3 protein, human
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0248306Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
J Cardiovasc Comput Tomogr. 2013 Jan-Feb;7(1):51-7
pubmed: 23333188
Eur Heart J. 2017 Sep 21;38(36):2739-2791
pubmed: 28886619
Circulation. 2018 Oct 30;138(18):1935-1947
pubmed: 30002099
J Am Coll Cardiol. 2020 Jan 28;75(3):304-316
pubmed: 31976869
N Engl J Med. 2010 Oct 21;363(17):1597-607
pubmed: 20961243
Circ Cardiovasc Imaging. 2020 May;13(5):e010358
pubmed: 32370615
Circulation. 2003 Feb 25;107(7):984-91
pubmed: 12600911
J Am Coll Cardiol. 2014 Jul 15;64(2):144-54
pubmed: 25011718
JACC Cardiovasc Imaging. 2020 Jan;13(1 Pt 1):44-54
pubmed: 31103587
Radiology. 2012 Sep;264(3):876-83
pubmed: 22771879
JACC Cardiovasc Imaging. 2017 Nov;10(11):1320-1333
pubmed: 28017384
Eur Heart J. 2018 Feb 21;39(8):699-709
pubmed: 29020257
Eur Heart J. 2017 Dec 1;38(45):3351-3358
pubmed: 29020232
J Cardiovasc Comput Tomogr. 2016 May-Jun;10(3):237-41
pubmed: 26968674
JACC Cardiovasc Imaging. 2020 Oct;13(10):2177-2189
pubmed: 32771574
JACC Cardiovasc Imaging. 2020 Dec;13(12):2591-2601
pubmed: 33129731
J Pharmacol Exp Ther. 2014 Nov;351(2):336-43
pubmed: 25194021
Sci Transl Med. 2013 Jan 9;5(167):167sr1
pubmed: 23303606
J Am Coll Cardiol. 2008 Jun 24;51(25):2414-21
pubmed: 18565399
Eur Heart J. 2020 May 21;41(20):1903-1914
pubmed: 32049275
J Cardiovasc Comput Tomogr. 2019 Nov - Dec;13(6):315-318
pubmed: 30606655
Future Cardiol. 2011 Sep;7(5):643-50
pubmed: 21929344