Is myocardial fibrosis a hallmark of paradoxical low gradient aortic stenosis?
(2017) American college of cardiology 2017
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- Background: The pathophysiology of low gradient severe aortic stenosis [SAS] despite normal ejection fraction also referred to as paradoxical low gradient [PLG]-SAS, is controversial. It has been suggested that PLG- SAS was associated with a higher degree of myocardial fibrosis and a worse outcome than high-gradient (HG)-SAS. Methods: To test this, we obtained myocardial biopsies and measured myocardial extravascular volume fraction (ECV, %) by use of cardiac magnetic resonance (Modified Look-Locker imaging T1 mapping at 3 T) in 142 consecutive patients with moderate to severe AS (22 moderate AS, 62 HG-SAS, 58 PLG-SAS, including 23 low flow [LF] and 35 normal flow [NF] PLG-SAS). ECV was also measured in 33 normal age-matched controls. Results: ECV correlated with the amount of interstitial fibrosis (IF) on histology (r=0.75, p<0.01). The amount of IF was similar in all subgroups (4±4% in NF-PLG- SAS, 5±3% in LF-PLG-SAS, 6±6% in HG-SAS) as were ECV values (29±4% in moderate AS, 29±6% in NF-LG-SAS, 29±3% in PLF-LG-SAS, 28± 6% in HG-SAS, p=0.9). No differences in ECV were found between SAS patients and controls (27±4%, p=0.33). The number of SAS patients with ECV values > 95% CI of controls was similar in each group (1/23 [4%] LF-PLG-SAS, 3/35 [9%] NF-PLG-SAS and 6/62 [10%] HG-SAS, p=ns; Figure). Conclusions: Our results demonstrate that the amount of IF, measured by histology or ECS is similar among controls and patients with SAS. These data do not support the contention that PLG-SAS is associated with higher degree of IF.
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Slimani, A., Roy, C., de Meester de Ravenstein, C., Amzulescu, M. S., Beauloye, C., Pouleur, A.-C., Vancraeynest, D., Pasquet, A., Gerber, B., & Vanoverschelde, J.-L. (2017). Is myocardial fibrosis a hallmark of paradoxical low gradient aortic stenosis? Journal of the American College of Cardiology, 69, 34833-34837. https://hdl.handle.net/2078.5/175008 (Original work published 2017)