PMID- 25011718 OWN - NLM STAT- MEDLINE DCOM- 20140909 LR - 20220321 IS - 1558-3597 (Electronic) IS - 0735-1097 (Linking) VI - 64 IP - 2 DP - 2014 Jul 15 TI - Prognostic significance of LGE by CMR in aortic stenosis patients undergoing valve replacement. PG - 144-54 LID - S0735-1097(14)02439-5 [pii] LID - 10.1016/j.jacc.2014.02.612 [doi] AB - BACKGROUND: Prior studies have shown that late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) can detect focal fibrosis in aortic stenosis (AS), suggesting that it might predict higher mortality risk. OBJECTIVES: This study was conducted to evaluate whether LGE-CMR can predict post-operative survival in patients with severe AS undergoing aortic valve replacement (AVR). METHODS: We prospectively evaluated survival (all-cause and cardiovascular disease related) according to LGE-CMR status in 154 consecutive AS patients (96 men; mean age: 74 +/- 6 years) without a history of myocardial infarction undergoing surgical AVR and in 40 AS patients undergoing transcatheter aortic valve replacement (TAVR). RESULTS: LGE was present in 29% of patients undergoing surgical AVR and in 50% undergoing TAVR. During a median follow-up of 2.9 years, 21 patients undergoing surgical AVR and 20 undergoing TAVR died. In surgical AVR, the presence of LGE predicted higher post-operative mortality (odds ratio: 10.9; 95% confidence interval [CI]: 1.2 to 100.0; p = 0.02) and worse all-cause survival (73% vs. 88%; p = 0.02 by log-rank test) and cardiovascular disease related survival (85% vs. 95%; p = 0.03 by log-rank test) on 5-year Kaplan-Meier estimates of survival after surgical AVR. Multivariate Cox analysis identified the presence of LGE (hazard ratio: 2.8; 95% CI: 1.3 to 6.9; p = 0.025) and New York Heart Association functional class III/IV (hazard ratio: 3.2; 95% CI: 1.1 to 8.1; p < 0.01) as the sole independent predictors of all-cause mortality after surgical AVR. The presence of LGE also predicted higher all-cause mortality (p = 0.05) and cardiovascular disease related mortality (p = 0.03) in the subgroup of patients without angiographic coronary artery disease (n = 110) and higher cardiovascular disease related mortality in 25 patients undergoing transfemoral TAVR. CONCLUSIONS: The presence of LGE indicating focal fibrosis or unrecognized infarct by CMR is an independent predictor of mortality in patients with AS undergoing AVR and could provide additional information in the pre-operative evaluation of risk in these patients. CI - Copyright (c) 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Barone-Rochette, Gilles AU - Barone-Rochette G AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Pierard, Sophie AU - Pierard S AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - De Meester de Ravenstein, Christophe AU - De Meester de Ravenstein C AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Seldrum, Stephanie AU - Seldrum S AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Melchior, Julie AU - Melchior J AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Maes, Frederic AU - Maes F AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Pouleur, Anne-Catherine AU - Pouleur AC AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Vancraeynest, David AU - Vancraeynest D AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Pasquet, Agnes AU - Pasquet A AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Vanoverschelde, Jean-Louis AU - Vanoverschelde JL AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. FAU - Gerber, Bernhard L AU - Gerber BL AD - Valvular Heart Disease Clinic, Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pole de Recherche Cardiovasculaire, Institut de Recherche Experimentale et Clinique, Universite Catholique de Louvain, Brussels, Belgium. Electronic address: Bernhard.gerber@uclouvain.be. LA - eng 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 (Contrast Media) RN - K2I13DR72L (Gadolinium DTPA) SB - IM CIN - J Am Coll Cardiol. 2014 Jul 15;64(2):155-7. PMID: 25011719 MH - Aged MH - Aortic Valve Stenosis/*diagnosis/mortality/surgery MH - Belgium/epidemiology MH - *Cardiac Catheterization MH - Cause of Death/trends MH - Contrast Media MH - Coronary Angiography MH - Echocardiography MH - Female MH - Follow-Up Studies MH - *Gadolinium DTPA MH - Heart Valve Prosthesis Implantation/*methods MH - Humans MH - Image Enhancement/*methods MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Preoperative Period MH - Prognosis MH - Prospective Studies MH - Reproducibility of Results MH - Severity of Illness Index MH - Survival Rate/trends OTO - NOTNLM OT - aortic stenosis OT - aortic valve replacement OT - late gadolinium enhanced cardiac magnetic resonance EDAT- 2014/07/12 06:00 MHDA- 2014/09/10 06:00 CRDT- 2014/07/12 06:00 PHST- 2013/08/28 00:00 [received] PHST- 2014/01/17 00:00 [revised] PHST- 2014/02/26 00:00 [accepted] PHST- 2014/07/12 06:00 [entrez] PHST- 2014/07/12 06:00 [pubmed] PHST- 2014/09/10 06:00 [medline] AID - S0735-1097(14)02439-5 [pii] AID - 10.1016/j.jacc.2014.02.612 [doi] PST - ppublish SO - J Am Coll Cardiol. 2014 Jul 15;64(2):144-54. doi: 10.1016/j.jacc.2014.02.612.