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Myocardial scar and remodelling predict long-term mortality in severe aortic stenosis beyond 10 years

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posted on 2024-05-13, 15:58 authored by George D Thornton, Vassilios S Vassiliou, Tarique A Musa, Nikoo Aziminia, Neil Craig, Abhishek Dattani, Rhodri H Davies, Gabriella Captur, James C Moon, Marc R Dweck, Saul G Myerson, Sanjay K Prasad, Gerry P McCann, John P Greenwood, Anvesha Singh, Thomas A Treibel, Petra Bijsterveld, Laura E Dobson, James RJ Foley, Graham R Law, Margaret Loudon, Tamir Malley, Silvia Pica, Marzia Rigolli, Lydia Sulaiman

Aortic stenosis (AS) is characterized by the narrowing of the aortic valve and compensatory myocardial remodelling.1 However, ultimately the left ventricle decompensates, leading to heart failure and death, and intervention is advised for severe AS accompanied by either symptoms or left ventricular (LV) dysfunction.2 Yet, over half of patients receiving aortic valve replacement (AVR) have irreversible myocardial scarring.3 Our multi-centre UK consortium linked pre-operative myocardial scarring, detected by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) with increased all-cause and cardiovascular (CV) mortality, regardless of intervention type, after a median of 3.5 years.4 With the integration of machine learning for CMR analysis, we achieve 40% greater precision than human assessment, potentially uncovering patterns obscured by human variability.5 We now examine whether the association of myocardial scar with mortality persists over longer-term follow-up.

Funding

Cardiovascular MR evaluation of the safety and efficacy of Transcatheter Aortic Valve Implantation (TAVI) compared to surgical Aortic Valve Replacement (AVR)

British Heart Foundation

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Contribution of LVH and diastolic dysfunction assessed by myocardial tissue tagging to symptoms and exercise intolerance in severe aortic stenosis

British Heart Foundation

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University of Oxford, Prof Myerson [FS/10/015/28104]; University of Edinburgh, Dr Dweck [FS/10/026]; University College London, Prof Moon [FS/08/028/24767]), Dr Treibel [FS/19/35/34374], Dr Thornton [FS/CRTF/21/2412] and the National Institute for Health Research (University College London, Dr Treibel [DRF-2013-06-102]), including via its Biomedical Research Centre and Clinical Research Facility programmes, as well as Rosetrees Trust.

History

Author affiliation

College of Life Sciences/Cardiovascular Sciences

Version

  • VoR (Version of Record)

Published in

European Heart Journal

Pagination

ehae067

Publisher

Oxford University Press (OUP)

issn

0195-668X

eissn

1522-9645

Copyright date

2024

Available date

2024-05-13

Spatial coverage

England

Language

en

Deposited by

Dr Anvesha Singh

Deposit date

2024-05-09

Data Access Statement

Data is available on request.

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