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Prognostic Signicance of  LGE by CMR in Aortic Stenosis Patients Undergoing Valve Replacement


Gilles  Barone-Rochette, MD, Sophie Piérard, MD, Christophe De Meester de Ravenstein, MS, Stéphanie Seldrum, MD, Julie Melchior, MD, Frédéric Maes, MD, Anne-Catherine Pouleur, MD, PHD,  David Vancraeynest, MD, PHD, Agnes Pasquet, MD, PHD,  Jean-Louis Vanoverschelde, MD, PHD,  Bernhard L. Gerber, MD, PHD







BACKGROUND Prior studies have  shown  that late  gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) can detect focal  fibrosis  in aortic  stenosis (AS), suggesting that it might  predict higher  mortality risk.


OBJECTIVES This study  was conducted to evaluate whether LGE-CMR can predict post-operative survival in patients with severe AS undergoing aortic  valve  replacement (AVR).


METHODS We prospectively evaluated survival (all-cause and  cardiovascular disease related) according to LGE-CMR status in 154 consecutive AS patients (96  men;  mean  age:  74      6 years)  without a history  of myocardial infarction un- dergoing surgical  AVR and  in 40 AS patients undergoing transcatheter aortic  valve  replacement (TAVR).


RESULTS LGE was  present in 29%  of  patients  undergoing surgical  AVR and  in 50% undergoing TAVR. During  a median  follow-up of 2.9  years,  21 patients undergoing surgical  AVR and  20 undergoing TAVR died.  In surgical  AVR, the  presence of  LGE predicted higher  post-operative mortality (odds  ratio:  10.9;  95%  confidence interval  [CI]:

1.2 to 100.0; p ¼ 0.02) and  worse  all-cause survival  (73%  vs. 88%; p ¼ 0.02 by log-rank test) and  cardiovascular disease related survival  (85%  vs.  95%;  p ¼ 0.03 by log-rank test) on  5-year  Kaplan-Meier  estimates of  survival

after  surgical  AVR. Multivariate Cox analysis  identified the presence of LGE (hazard  ratio:  2.8;  95%  CI: 1.3 to 6.9; p ¼ 0.025) anNew York Heart  Association  functional class  III/IV (hazard ratio:  3.2; 95%  CI: 1.1 to 8.1; p < 0.01) as the  sole  independent  predictors of  all-cause mortality  after  surgical  AVR. The  presence of  LGE also  predicted

higher  all-cause mortality (p  ¼ 0.05) and  cardiovascular disease relatemortality (p  ¼ 0.03) in the subgroup of patients without angiographic coronary artery disease (n ¼ 110) and  higher  cardiovascular disease related mortality in 25 patients undergoing transfemoral TAVR.


CONCLUSIONS The presence of LGE indicating focal fibrosis or unrecognized infarct by CMR is an independent predictor of mortality in patients with AS undergoing AVR and could provide  additional information in the pre-operative evaluation of risk in these patients. (J Am Coll Cardiol 2014;64:144–54) © 2014 by the  American College of Cardiology Foundation.



Severe degenerativaortic stenosis (AS)  is  the most frequent valvular heart disease in  indus- trialized countries and its prevalence steadily afterload and ventricular wall stress of this condition stimulatlefventricular hypertrophic  remodeling. Such remodeling is frequently associated with devel- fibrosis  (2–6), increase wit age     (1).    Th increase pressure opment  o adverse  intramyocardial ...


From the Valvular Heart Disease Clinic,  Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc,  Pôle  de Recherche Cardiovasculaire, Institut de  Recherche Expérimentale et Clinique, Université Catholique de  Louvain, Brussels, Belgium. Grant support was  received from the Fondation Nationale de  la Recherche Scientifique of the Belgian gov- ernment (FRSM 3.4598.08, FRSM 3.4508.12.f, FRSM 3.4.589.06.f, and FRSM 1.A461.12). Dr. Barone-Rochette was  supported by a grant from the French Federation of Cardiology. Drs.  Piérard, Seldrum, and Melchior were supported by a fellowship (Aspirant Candidat Specialiste Doctorant) of  the Fondation Nationale de  la Recherche Scientifique of  the Belgian government. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Barone-Rochette and Piérard contributed equally to  this work and are  joint first authors.Manuscript received August 28, 2013; revised manuscript received January 17, 2014,  accepted February 26, 2014.


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