PMID- 29020257
OWN - NLM
STAT- MEDLINE
DCOM- 20191127
LR  - 20210109
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 39
IP  - 8
DP  - 2018 Feb 21
TI  - Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and 
      non-invasive study in 133 patients.
PG  - 699-709
LID - 10.1093/eurheartj/ehx353 [doi]
AB  - AIMS: To investigate myocardial fibrosis (MF) in a large series of severe aortic 
      stenosis (AS) patients using invasive biopsy and non-invasive imaging. METHODS 
      AND RESULTS: One hundred thirty-three patients with severe, symptomatic AS 
      accepted for surgical aortic valve replacement underwent cardiovascular magnetic 
      resonance (CMR) with late gadolinium enhancement (LGE) and extracellular volume 
      fraction (ECV) quantification. Intra-operative left ventricular (LV) biopsies 
      were performed by needle or scalpel, yielding tissue with (n = 53) and without 
      endocardium (n = 80), and compared with 10 controls. Myocardial fibrosis occurred 
      in three patterns: (i) thickened endocardium with a fibrotic layer; (ii) 
      microscopic scars, with a subendomyocardial predominance; and (iii) diffuse 
      interstitial fibrosis. Collagen volume fraction (CVF) was elevated (P < 0.001) 
      compared with controls, and higher (P < 0.001) in endocardium-containing samples 
      with a decreasing CVF gradient from the subendocardium (P = 0.001). Late 
      gadolinium enhancement correlated with CVF (P < 0.001) but not ECV. Both LGE and 
      ECV correlated independently (P < 0.001) with N-terminal pro-brain natriuretic 
      peptide and high-sensitivity-troponin T. High ECV was also associated with worse 
      LV remodelling, left ventricular ejection fraction and functional capacity. 
      Combining high ECV and LGE better identified patients with more adverse LV 
      remodelling, blood biomarkers and histological parameters, and worse functional 
      capacity than each parameter alone. CONCLUSION: Myocardial fibrosis in severe AS 
      is complex, but three main patterns exist: endocardial fibrosis, microscars 
      (mainly in the subendomyocardium), and diffuse interstitial fibrosis. Neither 
      histological CVF nor the CMR parameters ECV and LGE capture fibrosis in its 
      totality. A combined, multi-parametric approach with ECV and LGE allows best 
      stratification of AS patients according to the response of the myocardial 
      collagen matrix.
CI  - (c) The Author 2017. Published by Oxford University Press on behalf of the European 
      Society of Cardiology
FAU - Treibel, Thomas A
AU  - Treibel TA
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
AD  - Institute for Cardiovascular Sciences, University College London, Gower Street, 
      London WC1E 6BT, UK.
FAU - Lopez, Begona
AU  - Lopez B
AD  - Program of Cardiovascular Diseases, Center for Applied Medical Research, 
      University of Navarra, Avda/ Pio XII 55, 31008, Pamplona, Spain.
AD  - CIBERCV, National Institute of Health Carlos III, C/ Monforte de Lemos 3-5, 
      28029, Madrid, Spain.
FAU - Gonzalez, Arantxa
AU  - Gonzalez A
AD  - Program of Cardiovascular Diseases, Center for Applied Medical Research, 
      University of Navarra, Avda/ Pio XII 55, 31008, Pamplona, Spain.
AD  - CIBERCV, National Institute of Health Carlos III, C/ Monforte de Lemos 3-5, 
      28029, Madrid, Spain.
FAU - Menacho, Katia
AU  - Menacho K
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
FAU - Schofield, Rebecca S
AU  - Schofield RS
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
FAU - Ravassa, Susana
AU  - Ravassa S
AD  - Program of Cardiovascular Diseases, Center for Applied Medical Research, 
      University of Navarra, Avda/ Pio XII 55, 31008, Pamplona, Spain.
AD  - CIBERCV, National Institute of Health Carlos III, C/ Monforte de Lemos 3-5, 
      28029, Madrid, Spain.
FAU - Fontana, Marianna
AU  - Fontana M
AD  - Institute for Cardiovascular Sciences, University College London, Gower Street, 
      London WC1E 6BT, UK.
FAU - White, Steven K
AU  - White SK
AD  - Institute for Cardiovascular Sciences, University College London, Gower Street, 
      London WC1E 6BT, UK.
FAU - DiSalvo, Carmelo
AU  - DiSalvo C
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
FAU - Roberts, Neil
AU  - Roberts N
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
FAU - Ashworth, Michael T
AU  - Ashworth MT
AD  - Institute for Cardiovascular Sciences, University College London, Gower Street, 
      London WC1E 6BT, UK.
AD  - Department of Histopathology, Great Ormond Street Hospital for Children National 
      Health Service Trust, Great Ormond Street, London WC1N 3JH, UK.
FAU - Diez, Javier
AU  - Diez J
AD  - Program of Cardiovascular Diseases, Center for Applied Medical Research, 
      University of Navarra, Avda/ Pio XII 55, 31008, Pamplona, Spain.
AD  - CIBERCV, National Institute of Health Carlos III, C/ Monforte de Lemos 3-5, 
      28029, Madrid, Spain.
AD  - Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Avda/ 
      Pio XII 36, 31008, Pamplona, Spain.
FAU - Moon, James C
AU  - Moon JC
AD  - Cardiac Imaging, Barts Heart Centre, St. Bartholomew's Hospital, 2nd Floor, King 
      George V Block, Barts Heart Centre, St. Bartholomew's Hospital, London EC1A 7BE, 
      UK.
AD  - Institute for Cardiovascular Sciences, University College London, Gower Street, 
      London WC1E 6BT, UK.
LA  - eng
GR  - DRF-2013-06-102/DH_/Department of Health/United Kingdom
GR  - FS/16/31/32185/BHF_/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (N-terminal proatrial natriuretic peptide)
RN  - 0 (Protein Precursors)
RN  - 0 (Troponin T)
RN  - 85637-73-6 (Atrial Natriuretic Factor)
RN  - AU0V1LM3JT (Gadolinium)
SB  - IM
CIN - Eur Heart J. 2018 Feb 21;39(8):710-712. PMID: 29020296
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/complications/diagnostic imaging/metabolism/*surgery
MH  - Atrial Natriuretic Factor/metabolism
MH  - Biopsy
MH  - Cardiomyopathies/diagnostic imaging/metabolism/*pathology
MH  - Female
MH  - Gadolinium/metabolism
MH  - Heart Valve Prosthesis Implantation/methods
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Magnetic Resonance Imaging, Cine
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Protein Precursors/metabolism
MH  - Troponin T/metabolism
PMC - PMC5888951
EDAT- 2017/10/12 06:00
MHDA- 2019/11/28 06:00
PMCR- 2017/07/22
CRDT- 2017/10/12 06:00
PHST- 2017/01/20 00:00 [received]
PHST- 2017/06/23 00:00 [accepted]
PHST- 2017/10/12 06:00 [pubmed]
PHST- 2019/11/28 06:00 [medline]
PHST- 2017/10/12 06:00 [entrez]
PHST- 2017/07/22 00:00 [pmc-release]
AID - 3978808 [pii]
AID - ehx353 [pii]
AID - 10.1093/eurheartj/ehx353 [doi]
PST - ppublish
SO  - Eur Heart J. 2018 Feb 21;39(8):699-709. doi: 10.1093/eurheartj/ehx353.