Myocardial Scar and Mortality in Severe Aortic Stenosis

• DOI: 10.1161/circulationaha.117.032839
• Publication Date: 2018-07-12T09:26:29Z
• Authors: Tarique A. Musa; Thomas A. Treibel; Vassiliou S. Vass...; Gabriella Captur; Anvesha Singh; Calvin Chin; Laura E. Dobson; Silvia Pica; Margaret Loudon; Tamir Malley; Marzia Rigolli; James R.J. Foley; Petra Bijsterveld; Graham R. Law; Marc R. Dweck; Saul G. Myerson; Gerry P. McCann; Sanjay K. Prasad; James C. Moon; John P. Greenwood
• Keywords: 610; aortic stenosis; aortic valve stenosis; scar; mortality; 3. Good health; cardiovascular magnetic resonance; 03 medical and health sciences; 0302 clinical medicine; Original Research Articles; 616; myocardium; magnetic resonance imaging

Background: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim this study was to determine whether presence focal scar preoperatively associated with long-term mortality. Methods: In a longitudinal observational outcome study, survival analysis performed patients severe listed intervention at 6 UK cardiothoracic centers. Patients underwent preprocedural echocardiography (for severity assessment) cardiovascular magnetic resonance ventricular volumes, function quantification between January 2003 May 2015. Myocardial categorized into 3 patterns (none, infarct, or noninfarct patterns) quantified full width half-maximum method as percentage left ventricle. All-cause mortality were tracked minimum 2 years. Results: Six hundred seventy-four (age, 75±14 years; 63% male; area, 0.38±0.14 cm /m ; mean gradient, 46±18 mm Hg; ejection fraction, 61.0±16.7%) included. Scar present 51% (18% infarct pattern, 33% noninfarct). Management surgical AVR (n=399) transcatheter (n=275). During follow-up (median, 3.6 years), 145 (21.5%) died (52 after AVR, 93 AVR). multivariable analysis, factors independently all-cause age (hazard ratio [HR], 1.50; 95% CI, 1.11–2.04; P =0.009, scaled by epochs 10 Society Thoracic Surgeons score (HR, 1.12; 1.03–1.22; =0.007), 2.39; 1.40–4.05; =0.001). predicted (26.4% versus 12.9%; <0.001) (15.0% 4.8%; mortality, regardless (transcatheter =0.002; =0.026 [all-cause mortality]). Every 1% increase burden 11% higher hazard 1.11; 1.05–1.17; 8% 1.08; 1.01–1.17; <0.001). Conclusions: stenosis, gadolinium enhancement mortality; its 2-fold