Extracellular Myocardial Volume in Patients With Aortic Stenosis

Russell J. Everett; Thomas A. Treibel; Miho Fukui; Heesun  Lee; Marzia Rigolli; Anvesha Singh; Petra Bijsterveld; Lionel Tastet; Tarique Al Musa; Laura Dobson; Calvin Chin; Gabriella Captur; Sang Yong Om; Stephanie Wiesemann; Vanessa M. Ferreira; Stefan K. Piechnik; Jeanette Schulz-Menger; Erik B. Schelbert; Marie-Annick Clavel; David E. Newby; Saul G. Myerson; Phillipe  Pibarot; Sahmin Lee; João L. Cavalcante; Seung-Pyo Lee; Gerry P. McCann; John P. Greenwood; James C. Moon; Marc R. Dweck

doi:10.1016/j.jacc.2019.11.032

Extracellular Myocardial Volume in Patients With Aortic Stenosis

Russell J. Everett, Thomas A. Treibel, Miho Fukui, Heesun Lee, Marzia Rigolli, Anvesha Singh, Petra Bijsterveld, Lionel Tastet, Tarique Al Musa, Laura Dobson, Calvin Chin, Gabriella Captur, Sang Yong Om, Stephanie Wiesemann, Vanessa M. Ferreira, Stefan K. Piechnik, Jeanette Schulz-Menger, Erik B. Schelbert, Marie-Annick Clavel, David E. NewbySaul G. Myerson, Phillipe Pibarot, Sahmin Lee, João L. Cavalcante, Seung-Pyo Lee, Gerry P. McCann, John P. Greenwood, James C. Moon, Marc R. Dweck

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

Background: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis.

Objectives: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes.

Methods: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery–based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters.

Results: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013).

Conclusions: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.

Original language	English
Pages (from-to)	304-316
Journal	Journal of the American College of Cardiology
Volume	75
Issue number	3
Early online date	20 Jan 2020
DOIs	https://doi.org/10.1016/j.jacc.2019.11.032
Publication status	Published - 28 Jan 2020

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Marc Dweck
- mdweckstaffmail.ed.acuk
- Deanery of Clinical Sciences - Personal Chair of Clinical Cardiology
- Centre for Cardiovascular Science
- Edinburgh Imaging
Person: Academic: Research Active (Research Assistant)

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Everett, R. J., Treibel, T. A., Fukui, M., Lee, H., Rigolli, M., Singh, A., Bijsterveld, P., Tastet, L., Musa, T. A., Dobson, L., Chin, C., Captur, G., Yong Om, S., Wiesemann, S., Ferreira, V. M., Piechnik, S. K., Schulz-Menger, J., Schelbert, E. B., Clavel, M.-A., ... Dweck, M. R. (2020). Extracellular Myocardial Volume in Patients With Aortic Stenosis. Journal of the American College of Cardiology, 75(3), 304-316. https://doi.org/10.1016/j.jacc.2019.11.032

@article{39e599d10fc24ac7928641382d96f657,

title = "Extracellular Myocardial Volume in Patients With Aortic Stenosis",

abstract = "Background: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis.Objectives: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes.Methods: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery–based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters.Results: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013).Conclusions: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.",

author = "Everett, {Russell J.} and Treibel, {Thomas A.} and Miho Fukui and Heesun Lee and Marzia Rigolli and Anvesha Singh and Petra Bijsterveld and Lionel Tastet and Musa, {Tarique Al} and Laura Dobson and Calvin Chin and Gabriella Captur and {Yong Om}, Sang and Stephanie Wiesemann and Ferreira, {Vanessa M.} and Piechnik, {Stefan K.} and Jeanette Schulz-Menger and Schelbert, {Erik B.} and Marie-Annick Clavel and Newby, {David E.} and Myerson, {Saul G.} and Phillipe Pibarot and Sahmin Lee and Cavalcante, {Jo{\~a}o L.} and Seung-Pyo Lee and McCann, {Gerry P.} and Greenwood, {John P.} and Moon, {James C.} and Dweck, {Marc R.}",

year = "2020",

month = jan,

day = "28",

doi = "10.1016/j.jacc.2019.11.032",

language = "English",

volume = "75",

pages = "304--316",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Elsevier Science",

number = "3",

}

Everett, RJ, Treibel, TA, Fukui, M, Lee, H, Rigolli, M, Singh, A, Bijsterveld, P, Tastet, L, Musa, TA, Dobson, L, Chin, C, Captur, G, Yong Om, S, Wiesemann, S, Ferreira, VM, Piechnik, SK, Schulz-Menger, J, Schelbert, EB, Clavel, M-A, Newby, DE, Myerson, SG, Pibarot, P, Lee, S, Cavalcante, JL, Lee, S-P, McCann, GP, Greenwood, JP, Moon, JC & Dweck, MR 2020, 'Extracellular Myocardial Volume in Patients With Aortic Stenosis', Journal of the American College of Cardiology, vol. 75, no. 3, pp. 304-316. https://doi.org/10.1016/j.jacc.2019.11.032

TY - JOUR

T1 - Extracellular Myocardial Volume in Patients With Aortic Stenosis

AU - Everett, Russell J.

AU - Treibel, Thomas A.

AU - Fukui, Miho

AU - Lee, Heesun

AU - Rigolli, Marzia

AU - Singh, Anvesha

AU - Bijsterveld, Petra

AU - Tastet, Lionel

AU - Musa, Tarique Al

AU - Dobson, Laura

AU - Chin, Calvin

AU - Captur, Gabriella

AU - Yong Om, Sang

AU - Wiesemann, Stephanie

AU - Ferreira, Vanessa M.

AU - Piechnik, Stefan K.

AU - Schulz-Menger, Jeanette

AU - Schelbert, Erik B.

AU - Clavel, Marie-Annick

AU - Newby, David E.

AU - Myerson, Saul G.

AU - Pibarot, Phillipe

AU - Lee, Sahmin

AU - Cavalcante, João L.

AU - Lee, Seung-Pyo

AU - McCann, Gerry P.

AU - Greenwood, John P.

AU - Moon, James C.

AU - Dweck, Marc R.

PY - 2020/1/28

Y1 - 2020/1/28

N2 - Background: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis.Objectives: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes.Methods: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery–based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters.Results: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013).Conclusions: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.

AB - Background: Myocardial fibrosis is a key mechanism of left ventricular decompensation in aortic stenosis and can be quantified using cardiovascular magnetic resonance (CMR) measures such as extracellular volume fraction (ECV%). Outcomes following aortic valve intervention may be linked to the presence and extent of myocardial fibrosis.Objectives: This study sought to determine associations between ECV% and markers of left ventricular decompensation and post-intervention clinical outcomes.Methods: Patients with severe aortic stenosis underwent CMR, including ECV% quantification using modified Look-Locker inversion recovery–based T1 mapping and late gadolinium enhancement before aortic valve intervention. A central core laboratory quantified CMR parameters.Results: Four-hundred forty patients (age 70 ± 10 years, 59% male) from 10 international centers underwent CMR a median of 15 days (IQR: 4 to 58 days) before aortic valve intervention. ECV% did not vary by scanner manufacturer, magnetic field strength, or T1 mapping sequence (all p > 0.20). ECV% correlated with markers of left ventricular decompensation including left ventricular mass, left atrial volume, New York Heart Association functional class III/IV, late gadolinium enhancement, and lower left ventricular ejection fraction (p < 0.05 for all), the latter 2 associations being independent of all other clinical variables (p = 0.035 and p < 0.001). After a median of 3.8 years (IQR: 2.8 to 4.6 years) of follow-up, 52 patients had died, 14 from adjudicated cardiovascular causes. A progressive increase in all-cause mortality was seen across tertiles of ECV% (17.3, 31.6, and 52.7 deaths per 1,000 patient-years; log-rank test; p = 0.009). Not only was ECV% associated with cardiovascular mortality (p = 0.003), but it was also independently associated with all-cause mortality following adjustment for age, sex, ejection fraction, and late gadolinium enhancement (hazard ratio per percent increase in ECV%: 1.10; 95% confidence interval [1.02 to 1.19]; p = 0.013).Conclusions: In patients with severe aortic stenosis scheduled for aortic valve intervention, an increased ECV% is a measure of left ventricular decompensation and a powerful independent predictor of mortality.

U2 - 10.1016/j.jacc.2019.11.032

DO - 10.1016/j.jacc.2019.11.032

M3 - Article

SN - 0735-1097

VL - 75

SP - 304

EP - 316

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 3

ER -

Extracellular Myocardial Volume in Patients With Aortic Stenosis

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