PMID- 21903062
OWN - NLM
STAT- MEDLINE
DCOM- 20111027
LR  - 20220318
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 58
IP  - 12
DP  - 2011 Sep 13
TI  - Midwall fibrosis is an independent predictor of mortality in patients with aortic 
      stenosis.
PG  - 1271-9
LID - 10.1016/j.jacc.2011.03.064 [doi]
AB  - OBJECTIVES: The goal of this study was to assess the prognostic significance of 
      midwall and infarct patterns of late gadolinium enhancement (LGE) in aortic 
      stenosis. BACKGROUND: Myocardial fibrosis occurs in aortic stenosis as part of 
      the hypertrophic response. It can be detected by LGE, which is associated with an 
      adverse prognosis in a range of other cardiac conditions. METHODS: Between 
      January 2003 and October 2008, consecutive patients with moderate or severe 
      aortic stenosis undergoing cardiovascular magnetic resonance with administration 
      of gadolinium contrast were enrolled into a registry. Patients were categorized 
      into absent, midwall, or infarct patterns of LGE by blinded independent 
      observers. Patient follow-up was completed using patient questionnaires, source 
      record data, and the National Strategic Tracing Service. RESULTS: A total of 143 
      patients (age 68 +/- 14 years; 97 male) were followed up for 2.0 +/- 1.4 years. 
      Seventy-two underwent aortic valve replacement, and 27 died (24 cardiac, 3 sudden 
      cardiac deaths). Compared with those with no LGE (n = 49), univariate analysis 
      revealed that patients with midwall fibrosis (n = 54) had an 8-fold increase in 
      all-cause mortality despite similar aortic stenosis severity and coronary artery 
      disease burden. Patients with an infarct pattern (n = 40) had a 6-fold increase. 
      Midwall fibrosis (hazard ratio: 5.35; 95% confidence interval: 1.16 to 24.56; p = 
      0.03) and ejection fraction (hazard ratio: 0.96; 95% confidence interval: 0.94 to 
      0.99; p = 0.01) were independent predictors of all-cause mortality by 
      multivariate analysis. CONCLUSIONS: Midwall fibrosis was an independent predictor 
      of mortality in patients with moderate and severe aortic stenosis. It has 
      incremental prognostic value to ejection fraction and may provide a useful method 
      of risk stratification.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Dweck, Marc R
AU  - Dweck MR
AD  - Royal Brompton Hospital, London, United Kingdom.
FAU - Joshi, Sanjiv
AU  - Joshi S
FAU - Murigu, Timothy
AU  - Murigu T
FAU - Alpendurada, Francisco
AU  - Alpendurada F
FAU - Jabbour, Andrew
AU  - Jabbour A
FAU - Melina, Giovanni
AU  - Melina G
FAU - Banya, Winston
AU  - Banya W
FAU - Gulati, Ankur
AU  - Gulati A
FAU - Roussin, Isabelle
AU  - Roussin I
FAU - Raza, Sadaf
AU  - Raza S
FAU - Prasad, Nishant A
AU  - Prasad NA
FAU - Wage, Rick
AU  - Wage R
FAU - Quarto, Cesare
AU  - Quarto C
FAU - Angeloni, Emiliano
AU  - Angeloni E
FAU - Refice, Simone
AU  - Refice S
FAU - Sheppard, Mary
AU  - Sheppard M
FAU - Cook, Stuart A
AU  - Cook SA
FAU - Kilner, Philip J
AU  - Kilner PJ
FAU - Pennell, Dudley J
AU  - Pennell DJ
FAU - Newby, David E
AU  - Newby DE
FAU - Mohiaddin, Raad H
AU  - Mohiaddin RH
FAU - Pepper, John
AU  - Pepper J
FAU - Prasad, Sanjay K
AU  - Prasad SK
LA  - eng
SI  - ClinicalTrials.gov/NCT00930735
GR  - FS/10/026/BHF_/British Heart Foundation/United Kingdom
GR  - FS/10/026/28209/BHF_/British Heart Foundation/United Kingdom
GR  - MC_U120085815/MRC_/Medical Research Council/United Kingdom
GR  - G0701127/MRC_/Medical Research Council/United Kingdom
GR  - SP/10/10/28431/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Radiopharmaceuticals)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - J Am Coll Cardiol. 2011 Sep 13;58(12):1280-2. PMID: 21903063
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/complications/*mortality
MH  - Female
MH  - Fibrosis
MH  - Gadolinium
MH  - Heart Ventricles/diagnostic imaging/pathology
MH  - Humans
MH  - Hypertrophy, Left Ventricular/*diagnostic imaging/etiology/pathology
MH  - Kaplan-Meier Estimate
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Prospective Studies
MH  - Radionuclide Imaging
MH  - Radiopharmaceuticals
MH  - Registries
MH  - Risk Assessment
EDAT- 2011/09/10 06:00
MHDA- 2011/10/28 06:00
CRDT- 2011/09/10 06:00
PHST- 2011/01/23 00:00 [received]
PHST- 2011/03/08 00:00 [revised]
PHST- 2011/03/17 00:00 [accepted]
PHST- 2011/09/10 06:00 [entrez]
PHST- 2011/09/10 06:00 [pubmed]
PHST- 2011/10/28 06:00 [medline]
AID - S0735-1097(11)02373-4 [pii]
AID - 10.1016/j.jacc.2011.03.064 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Sep 13;58(12):1271-9. doi: 10.1016/j.jacc.2011.03.064.