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European Radiology
Published in: European Radiology 6/2021

Open Access 01-06-2021 | Aortic Valve Replacement | Cardiac

Short-term adverse remodeling progression in asymptomatic aortic stenosis

Authors: Anvesha Singh, Daniel C. S. Chan, Prathap Kanagala, Kai Hogrefe, Damian J. Kelly, Jeffery P. Khoo, David Sprigings, John P. Greenwood, Ahmed M. S. E. K. Abdelaty, Michael Jerosch-Herold, Leong L. Ng, Gerry P. McCann

Published in: European Radiology | Issue 6/2021

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Abstract

Objectives

Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS.

Methods

Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI.

Results

Forty-three participants with moderate-severe AS (mean age 64.4 ± 14.8 years, 83.4% male, aortic valve area index 0.54 ± 0.15 cm2/m2) were included. There was small but significant increase in indexed left ventricular (LV) (90.7 ± 22.0 to 94.5 ± 23.1 ml/m2, p = 0.007) and left atrial volumes (52.9 ± 11.3 to 58.6 ± 13.6 ml/m2, p < 0.001), with a decrease in systolic (LV ejection fraction 57.9 ± 4.6 to 55.6 ± 4.1%, p = 0.001) and diastolic (longitudinal diastolic strain rate 1.06 ± 0.2 to 0.99 ± 0.2 1/s, p = 0.026) function, but no overall change in LV mass or mass/volume. Late gadolinium enhancement increased (2.02 to 4.26 g, p < 0.001) but markers of diffuse interstitial fibrosis did not change significantly (extracellular volume index 12.9 [11.4, 17.0] ml/m2 to 13.3 [11.1, 15.1] ml/m2, p = 0.689). There was also a significant increase in the levels of NT-proBNP (43.6 [13.45, 137.08] pg/ml to 53.4 [19.14, 202.20] pg/ml, p = 0.001).

Conclusions

There is progression in cardiac remodeling with increasing scar burden even in asymptomatic AS. Given the lack of reversibility of LGE post-AVR and its association with long-term mortality post-AVR, this suggests the potential need for earlier intervention, before the accumulation of LGE, to improve the long-term outcomes in AS.

Key Points

• Current guidelines recommend waiting until symptom onset before valve replacement in severe AS.
• MRI showed clear progression in cardiac remodeling over 12 months in asymptomatic patients with AS, with near doubling in LGE.
• This highlights the need for potentially earlier intervention or better risk stratification in AS.
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Metadata
Title
Short-term adverse remodeling progression in asymptomatic aortic stenosis
Authors
Anvesha Singh
Daniel C. S. Chan
Prathap Kanagala
Kai Hogrefe
Damian J. Kelly
Jeffery P. Khoo
David Sprigings
John P. Greenwood
Ahmed M. S. E. K. Abdelaty
Michael Jerosch-Herold
Leong L. Ng
Gerry P. McCann
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2021
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-020-07462-9

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