LGE prevalence and patterns in severe aortic stenosis: When “junctional” means the same

• Published in: International journal of cardiology 2023-05, Vol.378, p.159-163
• Main Authors: Maltês, Sérgio, Abecasis, João, Santos, Rita Reis, Lopes, Pedro, Oliveira, Luis, Guerreiro, Sara, Freitas, Pedro, Ferreira, António, Nolasco, Tiago, Gil, Victor, Cardim, Nuno
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic stenosis; Aortic Valve; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - epidemiology; Aortic Valve Stenosis - surgery; Cardiac magnetic resonance; Contrast Media; Fibrosis; Gadolinium; Humans; Late gadolinium enhancement; Magnetic Resonance Imaging, Cine - methods; Middle Aged; Predictive Value of Tests; Prevalence; Prospective Studies; Right ventricle insertion points; Ventricular Function, Left
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.02.034

Left ventricular (LV) remodeling in severe aortic valve stenosis (AS) is a complex process that goes beyond hypertrophic response. Reparative/replacement fibrosis is considered irreversible and has recognized value in both risk stratification and prognosis. Currently, cardiac magnetic resonance (CMR) is the gold-standard imaging technique for fibrosis identification through late gadolinium enhancement (LGE) assessment. However, its prevalence and distribution are quite variable among series. Our goal was to assess LGE prevalence and patterns in severe AS. Single-center prospective cohort of 140 patients with severe symptomatic high-gradient AS (mean age 72 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean LV ejection fraction by echocardiogram 58 ± 9%) undergoing surgical aortic valve replacement. Those with previous myocardial infarction and/or non-ischemic cardiomyopathy were excluded. All patients performed 1.5 T LGE-CMR prior to surgery. Overall, 103 patients (74%) had non-ischemic LGE (median LGE mass 2.8 g [IQR 0.0–7.8] g), many of them with combined mid-wall and junctional enhancement pattern (36%). LGE was most frequently observed in the mid-basal segments of the interventricular septum. Seventy-four patients (53%) had non-exclusively junctional LGE. Contrary to those with junctional enhancement, patients with non-exclusively junctional LGE had higher LV volumes/mass, worse LV ejection fraction and worse global longitudinal strain. Among patients with severe, symptomatic, high-gradient AS, LGE is frequent, primarily affecting the mid-basal interventricular septum. Contrary to junctional LGE, the presence of non-junctional LGE seems to correlate with adverse markers of LV remodeling. •This is a prospective assessment of LGE patterns at CMR in severe aortic stenosis (AS) patients.•LGE was highly-prevalent (74% of patients), even if excluding those with non-exclusively junctional LGE (53%).•LGE was most often observed in the mid-basal inferior interventricular septum, possibly due to an increased wall thickness.•Junctional LGE seems to be independent from LV remodeling process leading to myocardial replacement in AS patients.•This is the largest study assessing LGE prevalence, patterns and distribution in a cohort of severe AS patients.