Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis

Miho Fukui; Mohamed-Salah Annabi; Vitor E E Rosa; Henrique B Ribeiro; Larissa I Stanberry; Marie-Annick Clavel; Josep Rodés-Cabau; Flavio Tarasoutchi; Erik B Schelbert; Jutta Bergler-Klein; Philipp E Bartko; Carolina Dona; Julia Mascherbauer; Abdellaziz Dahou; Carlos E Rochitte; Philippe Pibarot; João L Cavalcante

doi:10.1093/ehjci/jeac089

Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis

Miho Fukui, Mohamed-Salah Annabi, Vitor E E Rosa, Henrique B Ribeiro, Larissa I Stanberry, Marie-Annick Clavel, Josep Rodés-Cabau, Flavio Tarasoutchi, Erik B Schelbert, Jutta Bergler-Klein, Philipp E Bartko, Carolina Dona, Julia Mascherbauer, Abdellaziz Dahou, Carlos E Rochitte, Philippe Pibarot, João L Cavalcante

Division of Internal Medicine 3 (University Hospital St. Pölten)

Research output: Journal article (peer-reviewed) › Journal article

13 Citations (Scopus)

Abstract

AIMS: This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS.

METHODS AND RESULTS: This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF ≥ 50%, and stroke volume index (SVi) < 35 ml/m2]; and normal-flow low-gradient (MG < 40 mmHg, LVEF ≥ 50%, and SVi ≥ 35 ml/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment.

CONCLUSIONS: In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.

Original language	English
Pages (from-to)	46-58
Number of pages	13
Journal	European Heart Journal Cardiovascular Imaging
Volume	24
Issue number	1
Early online date	25 May 2022
DOIs	https://doi.org/10.1093/ehjci/jeac089
Publication status	Published - 01 Jan 2023

Keywords

Aortic Valve Stenosis
Contrast Media
Gadolinium
Humans
Magnetic Resonance Imaging, Cine/methods
Magnetic Resonance Spectroscopy
Prognosis
Prospective Studies
Stroke Volume
Ventricular Function, Left
extracellular volume fraction
global longitudinal strain
aortic stenosis
mortality
late gadolinium enhancement
cardiac magnetic resonance
low flow low gradient

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology, Nuclear Medicine and Imaging

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10.1093/ehjci/jeac089

Cite this

Fukui, M., Annabi, M.-S., Rosa, V. E. E., Ribeiro, H. B., Stanberry, L. I., Clavel, M.-A., Rodés-Cabau, J., Tarasoutchi, F., Schelbert, E. B., Bergler-Klein, J., Bartko, P. E., Dona, C., Mascherbauer, J., Dahou, A., Rochitte, C. E., Pibarot, P., & Cavalcante, J. L. (2023). Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis. European Heart Journal Cardiovascular Imaging, 24(1), 46-58. https://doi.org/10.1093/ehjci/jeac089

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title = "Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis",

abstract = "AIMS: This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS.METHODS AND RESULTS: This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF ≥ 50%, and stroke volume index (SVi) < 35 ml/m2]; and normal-flow low-gradient (MG < 40 mmHg, LVEF ≥ 50%, and SVi ≥ 35 ml/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment.CONCLUSIONS: In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.",

keywords = "Aortic Valve Stenosis, Contrast Media, Gadolinium, Humans, Magnetic Resonance Imaging, Cine/methods, Magnetic Resonance Spectroscopy, Prognosis, Prospective Studies, Stroke Volume, Ventricular Function, Left, extracellular volume fraction, global longitudinal strain, aortic stenosis, mortality, late gadolinium enhancement, cardiac magnetic resonance, low flow low gradient",

author = "Miho Fukui and Mohamed-Salah Annabi and Rosa, {Vitor E E} and Ribeiro, {Henrique B} and Stanberry, {Larissa I} and Marie-Annick Clavel and Josep Rod{\'e}s-Cabau and Flavio Tarasoutchi and Schelbert, {Erik B} and Jutta Bergler-Klein and Bartko, {Philipp E} and Carolina Dona and Julia Mascherbauer and Abdellaziz Dahou and Rochitte, {Carlos E} and Philippe Pibarot and Cavalcante, {Jo{\~a}o L}",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s).",

year = "2023",

month = jan,

day = "1",

doi = "10.1093/ehjci/jeac089",

language = "English",

volume = "24",

pages = "46--58",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

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Fukui, M, Annabi, M-S, Rosa, VEE, Ribeiro, HB, Stanberry, LI, Clavel, M-A, Rodés-Cabau, J, Tarasoutchi, F, Schelbert, EB, Bergler-Klein, J, Bartko, PE, Dona, C, Mascherbauer, J, Dahou, A, Rochitte, CE, Pibarot, P & Cavalcante, JL 2023, 'Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis', European Heart Journal Cardiovascular Imaging, vol. 24, no. 1, pp. 46-58. https://doi.org/10.1093/ehjci/jeac089

TY - JOUR

T1 - Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis

AU - Fukui, Miho

AU - Annabi, Mohamed-Salah

AU - Rosa, Vitor E E

AU - Ribeiro, Henrique B

AU - Stanberry, Larissa I

AU - Clavel, Marie-Annick

AU - Rodés-Cabau, Josep

AU - Tarasoutchi, Flavio

AU - Schelbert, Erik B

AU - Bergler-Klein, Jutta

AU - Bartko, Philipp E

AU - Dona, Carolina

AU - Mascherbauer, Julia

AU - Dahou, Abdellaziz

AU - Rochitte, Carlos E

AU - Pibarot, Philippe

AU - Cavalcante, João L

PY - 2023/1/1

Y1 - 2023/1/1

N2 - AIMS: This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS.METHODS AND RESULTS: This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF ≥ 50%, and stroke volume index (SVi) < 35 ml/m2]; and normal-flow low-gradient (MG < 40 mmHg, LVEF ≥ 50%, and SVi ≥ 35 ml/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment.CONCLUSIONS: In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.

AB - AIMS: This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS.METHODS AND RESULTS: This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF ≥ 50%, and stroke volume index (SVi) < 35 ml/m2]; and normal-flow low-gradient (MG < 40 mmHg, LVEF ≥ 50%, and SVi ≥ 35 ml/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment.CONCLUSIONS: In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.

KW - Aortic Valve Stenosis

KW - Contrast Media

KW - Gadolinium

KW - Humans

KW - Magnetic Resonance Imaging, Cine/methods

KW - Magnetic Resonance Spectroscopy

KW - Prognosis

KW - Prospective Studies

KW - Stroke Volume

KW - Ventricular Function, Left

KW - extracellular volume fraction

KW - global longitudinal strain

KW - aortic stenosis

KW - mortality

KW - late gadolinium enhancement

KW - cardiac magnetic resonance

KW - low flow low gradient

UR - http://www.scopus.com/inward/record.url?scp=85144589917&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jeac089

DO - 10.1093/ehjci/jeac089

M3 - Journal article

C2 - 35613021

SN - 2047-2404

VL - 24

SP - 46

EP - 58

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 1

ER -

Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis

Abstract

Keywords

ASJC Scopus subject areas

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