Late gadolinium enhancement in cardiac MRI in patients with severe aortic stenosis and preserved left ventricular systolic function is related to attenuated improvement of left ventricular geometry and filling pressure after aortic valve replacement

Junbeom Park, Hyuk Jae Chang, Jung Ho Choi, Pil Sung Yang, Sang Eun Lee, Ran Heo, Sanghoon Shin, In Jeong Cho, Young Jin Kim, Chi Young Shim, Geu Ru Hong, Namsik Chung

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Abstract

Background and Objectives: We investigated echocardiographic predictors: left ventricular (LV) geometric changes following aortic valve replacement (AVR) according to the late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with severe aortic stenosis (AS) and preserved LV systolic function.

Results: The group with LGE (LGE+) showed greater wall thickness (septum, 14.3±2.6 mm vs. 11.5±2.0 mm, p=0.001, posterior; 14.3±2.5 mm vs. 11.4±1.6 mm, p<0.001), lower tissue Doppler image (TDIS', 4.4±1.4 cm/s vs. 5.5±1.2 cm/s, p=0.021; TDI E', 3.2±0.9 cm/s vs. 4.8±1.4 cm/s, p=0.002), and greater E/e' (21.8±10.3 vs. 15.4±6.3, p=0.066) than those without LGE (LGE-). Multivariate analysis show that TDI e' (odds ratio=0.078, 95% confidence interval=0.007-0.888, p=0.040) was an independent determinant of LGE+. In an analysis of the 6- and 12-month follow-up compared with pre-AVR, LGE- showed decreased LV end-diastolic diameter (48.3±5.0 mm vs. 45.8±3.6 mm, p=0.027; 48.3±5.0 mm vs. 46.5±3.4 mm, p=0.019). Moreover, E/e' (at 12 months) showed further improved LV filling pressure (16.0±6.6 vs. 12.3±4.3, p=0.001) compared with pre-AVR. However, LGE+ showed no significant improvement.

Subjects and Methods: We analyzed 41 patients (24 males, 63.1±8.7 years) with preserved LV systolic function who were scheduled to undergo AVR for severe AS. All patients were examined with transthoracic echocardiography (TTE), CMR before and after AVR (in the hospital) and serial TTEs (at 6 and 12 months) were repeated.

Conclusion: The absence of LGE is associated with favorable improvements in LV geometry and filling pressure. TDI E' is an independent determinant of LGE in patients with severe AS and preserved LV systolic function.

Original languageEnglish
Pages (from-to)312-319
Number of pages8
JournalKorean Circulation Journal
Volume44
Issue number5
DOIs
Publication statusPublished - 2014 Sep 1

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All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

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