Multimodality imaging methods and systemic biomarkers in classical low-flow low-gradient aortic stenosis: Key findings for risk stratification

OBJECTIVES: The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS). BACKGROUND: Elevated levels of BNP and hsTnI ha...

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Detalles Bibliográficos
Autores principales: Lopes, Maria Antonieta Albanez A. de M., Campos, Carlos M., Rosa, Vitor Emer Egypto, Sampaio, Roney O., Morais, Thamara C., de Brito Júnior, Fábio Sândoli, Vieira, Marcelo L. C., Mathias, Wilson, Fernandes, Joao Ricardo Cordeiro, de Santis, Antonio, Santos, Luciano de Moura, Rochitte, Carlos E., Capodanno, Davide, Tamburino, Corrado, Abizaid, Alexandre, Tarasoutchi, Flavio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Cardiovascular Medicine
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174252/
https://www.ncbi.nlm.nih.gov/pubmed/37180790
http://dx.doi.org/10.3389/fcvm.2023.1149613
Descripción
Sumario:OBJECTIVES: The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers, high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, in low-flow, low-gradient aortic stenosis (LFLG-AS). BACKGROUND: Elevated levels of BNP and hsTnI have been related with poor prognosis in patients with LFLG-AS. METHODS: Prospective study with LFLG-AS patients that underwent hsTnI, BNP, coronary angiography, cardiac magnetic resonance (CMR) with T1 mapping, echocardiogram and dobutamine stress echocardiogram. Patients were divided into 3 groups according to BNP and hsTnI levels: Group 1 (n = 17) when BNP and hsTnI levels were below median [BNP < 1.98 fold upper reference limit (URL) and hsTnI < 1.8 fold URL]; Group 2 (n = 14) when BNP or hsTnI were higher than median; and Group 3 (n = 18) when both hsTnI and BNP were higher than median. RESULTS: 49 patients included in 3 groups. Clinical characteristics (including risk scores) were similar among groups. Group 3 patients had lower valvuloarterial impedance (P = 0.03) and lower left ventricular ejection fraction (P = 0.02) by echocardiogram. CMR identified a progressive increase of right and left ventricular chamber from Group 1 to Group 3, and worsening of left ventricular ejection fraction (EF) (40 [31–47] vs. 32 [29–41] vs. 26 [19–33]%; p < 0.01) and right ventricular EF (62 [53–69] vs. 51 [35–63] vs. 30 [24–46]%; p < 0.01). Besides, there was a marked increase in myocardial fibrosis assessed by extracellular volume fraction (ECV) (28.4 [24.8–30.7] vs. 28.2 [26.9–34.5] vs. 31.8 [28.9–35.5]%; p = 0.03) and indexed ECV (iECV) (28.7 [21.2–39.1] vs. 28.8 [25.4–39.9] vs. 44.2 [36.4–51.2] ml/m(2), respectively; p < 0.01) from Group 1 to Group 3. CONCLUSIONS: Higher levels of BNP and hsTnI in LFLG-AS patients are associated with worse multi-modality evidence of cardiac remodeling and fibrosis.

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