A clinical risk score of myocardial fibrosis predicts adverse outcomes in aortic stenosis

Calvin W. L. Chin, David Messika-Zeitoun, Anoop S.V. Shah, Guillaume Lefevre, Sophie Bailleul, Emily N.W. Yeung, Maria Koo, Saeed Mirsadraee, Tiffany Mathieu, Scott I. Semple, Nicholas L. Mills, Alec Vahanian, David E. Newby, Marc R. Dweck

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aims: Midwall myocardial fibrosis on cardiovascular magnetic resonance (CMR) is a marker of early ventricular decompensation and adverse outcomes in aortic stenosis (AS). We aimed to develop and validate a novel clinical score using variables associated with midwall fibrosis.

Methods and results: One hundred forty-seven patients (peak aortic velocity (Vmax) 3.9 [3.2,4.4] m/s) underwent CMR to determine midwall fibrosis (CMR cohort). Routine clinical variables that demonstrated significant association with midwall fibrosis were included in a multivariate logistic score. We validated the prognostic value of the score in two separate outcome cohorts of asymptomatic patients (internal: n = 127, follow-up 10.3 [5.7,11.2] years; external: n = 289, follow-up 2.6 [1.6,4.5] years). Primary outcome was a composite of AS-related events (cardiovascular death, heart failure, and new angina, dyspnoea, or syncope). The final score consisted of age, sex, Vmax, high-sensitivity troponin I concentration, and electrocardiographic strain pattern [c-statistic 0.85 (95% confidence interval 0.78–0.91), P < 0.001; Hosmer–Lemeshow χ2 = 7.33, P = 0.50]. Patients in the outcome cohorts were classified according to the sensitivity and specificity of this score (both at 98%): low risk (probability score <7%), intermediate risk (7–57%), and high risk (>57%). In the internal outcome cohort, AS-related event rates were >10-fold higher in high-risk patients compared with those at low risk (23.9 vs. 2.1 events/100 patient-years, respectively; log rank P < 0.001). Similar findings were observed in the external outcome cohort (31.6 vs. 4.6 events/100 patient-years, respectively; log rank P < 0.001).

Conclusion: We propose a clinical score that predicts adverse outcomes in asymptomatic AS patients and potentially identifies high-risk patients who may benefit from early valve replacement.

Original languageEnglish
Pages (from-to)713–723
Number of pages11
JournalEuropean Heart Journal
Issue number8
Early online date21 Oct 2015
Publication statusPublished - 21 Feb 2016


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