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Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium

BACKGROUND: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim of this study was to determine whether the presence of focal myocardial scar preoperativel...

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Autores principales: Musa, Tarique A., Treibel, Thomas A., Vassiliou, Vassiliou S., Captur, Gabriella, Singh, Anvesha, Chin, Calvin, Dobson, Laura E., Pica, Silvia, Loudon, Margaret, Malley, Tamir, Rigolli, Marzia, Foley, James R.J., Bijsterveld, Petra, Law, Graham R., Dweck, Marc R., Myerson, Saul G., McCann, Gerry P., Prasad, Sanjay K., Moon, James C., Greenwood, John P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221382/
https://www.ncbi.nlm.nih.gov/pubmed/30002099
http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032839
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author Musa, Tarique A.
Treibel, Thomas A.
Vassiliou, Vassiliou S.
Captur, Gabriella
Singh, Anvesha
Chin, Calvin
Dobson, Laura E.
Pica, Silvia
Loudon, Margaret
Malley, Tamir
Rigolli, Marzia
Foley, James R.J.
Bijsterveld, Petra
Law, Graham R.
Dweck, Marc R.
Myerson, Saul G.
McCann, Gerry P.
Prasad, Sanjay K.
Moon, James C.
Greenwood, John P.
author_facet Musa, Tarique A.
Treibel, Thomas A.
Vassiliou, Vassiliou S.
Captur, Gabriella
Singh, Anvesha
Chin, Calvin
Dobson, Laura E.
Pica, Silvia
Loudon, Margaret
Malley, Tamir
Rigolli, Marzia
Foley, James R.J.
Bijsterveld, Petra
Law, Graham R.
Dweck, Marc R.
Myerson, Saul G.
McCann, Gerry P.
Prasad, Sanjay K.
Moon, James C.
Greenwood, John P.
author_sort Musa, Tarique A.
collection PubMed
description BACKGROUND: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim of this study was to determine whether the presence of focal myocardial scar preoperatively was associated with long-term mortality. METHODS: In a longitudinal observational outcome study, survival analysis was performed in patients with severe aortic stenosis listed for valve intervention at 6 UK cardiothoracic centers. Patients underwent preprocedural echocardiography (for valve severity assessment) and cardiovascular magnetic resonance for ventricular volumes, function and scar quantification between January 2003 and May 2015. Myocardial scar was categorized into 3 patterns (none, infarct, or noninfarct patterns) and quantified with the full width at half-maximum method as percentage of the left ventricle. All-cause mortality and cardiovascular mortality were tracked for a minimum of 2 years. RESULTS: Six hundred seventy-four patients with severe aortic stenosis (age, 75±14 years; 63% male; aortic valve area, 0.38±0.14 cm(2)/m(2); mean gradient, 46±18 mm Hg; left ventricular ejection fraction, 61.0±16.7%) were included. Scar was present in 51% (18% infarct pattern, 33% noninfarct). Management was surgical AVR (n=399) or transcatheter AVR (n=275). During follow-up (median, 3.6 years), 145 patients (21.5%) died (52 after surgical AVR, 93 after transcatheter AVR). In multivariable analysis, the factors independently associated with all-cause mortality were age (hazard ratio [HR], 1.50; 95% CI, 1.11–2.04; P=0.009, scaled by epochs of 10 years), Society of Thoracic Surgeons score (HR, 1.12; 95% CI, 1.03–1.22; P=0.007), and scar presence (HR, 2.39; 95% CI, 1.40–4.05; P=0.001). Scar independently predicted all-cause (26.4% versus 12.9%; P<0.001) and cardiovascular (15.0% versus 4.8%; P<0.001) mortality, regardless of intervention (transcatheter AVR, P=0.002; surgical AVR, P=0.026 [all-cause mortality]). Every 1% increase in left ventricular myocardial scar burden was associated with 11% higher all-cause mortality hazard (HR, 1.11; 95% CI, 1.05–1.17; P<0.001) and 8% higher cardiovascular mortality hazard (HR, 1.08; 95% CI, 1.01–1.17; P<0.001). CONCLUSIONS: In patients with severe aortic stenosis, late gadolinium enhancement on cardiovascular magnetic resonance was independently associated with mortality; its presence was associated with a 2-fold higher late mortality.
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spelling pubmed-62213822018-11-21 Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium Musa, Tarique A. Treibel, Thomas A. Vassiliou, Vassiliou S. Captur, Gabriella Singh, Anvesha Chin, Calvin Dobson, Laura E. Pica, Silvia Loudon, Margaret Malley, Tamir Rigolli, Marzia Foley, James R.J. Bijsterveld, Petra Law, Graham R. Dweck, Marc R. Myerson, Saul G. McCann, Gerry P. Prasad, Sanjay K. Moon, James C. Greenwood, John P. Circulation Original Research Articles BACKGROUND: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim of this study was to determine whether the presence of focal myocardial scar preoperatively was associated with long-term mortality. METHODS: In a longitudinal observational outcome study, survival analysis was performed in patients with severe aortic stenosis listed for valve intervention at 6 UK cardiothoracic centers. Patients underwent preprocedural echocardiography (for valve severity assessment) and cardiovascular magnetic resonance for ventricular volumes, function and scar quantification between January 2003 and May 2015. Myocardial scar was categorized into 3 patterns (none, infarct, or noninfarct patterns) and quantified with the full width at half-maximum method as percentage of the left ventricle. All-cause mortality and cardiovascular mortality were tracked for a minimum of 2 years. RESULTS: Six hundred seventy-four patients with severe aortic stenosis (age, 75±14 years; 63% male; aortic valve area, 0.38±0.14 cm(2)/m(2); mean gradient, 46±18 mm Hg; left ventricular ejection fraction, 61.0±16.7%) were included. Scar was present in 51% (18% infarct pattern, 33% noninfarct). Management was surgical AVR (n=399) or transcatheter AVR (n=275). During follow-up (median, 3.6 years), 145 patients (21.5%) died (52 after surgical AVR, 93 after transcatheter AVR). In multivariable analysis, the factors independently associated with all-cause mortality were age (hazard ratio [HR], 1.50; 95% CI, 1.11–2.04; P=0.009, scaled by epochs of 10 years), Society of Thoracic Surgeons score (HR, 1.12; 95% CI, 1.03–1.22; P=0.007), and scar presence (HR, 2.39; 95% CI, 1.40–4.05; P=0.001). Scar independently predicted all-cause (26.4% versus 12.9%; P<0.001) and cardiovascular (15.0% versus 4.8%; P<0.001) mortality, regardless of intervention (transcatheter AVR, P=0.002; surgical AVR, P=0.026 [all-cause mortality]). Every 1% increase in left ventricular myocardial scar burden was associated with 11% higher all-cause mortality hazard (HR, 1.11; 95% CI, 1.05–1.17; P<0.001) and 8% higher cardiovascular mortality hazard (HR, 1.08; 95% CI, 1.01–1.17; P<0.001). CONCLUSIONS: In patients with severe aortic stenosis, late gadolinium enhancement on cardiovascular magnetic resonance was independently associated with mortality; its presence was associated with a 2-fold higher late mortality. Lippincott Williams & Wilkins 2018-10-30 2018-10-29 /pmc/articles/PMC6221382/ /pubmed/30002099 http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032839 Text en © 2018 The Authors. Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.
spellingShingle Original Research Articles
Musa, Tarique A.
Treibel, Thomas A.
Vassiliou, Vassiliou S.
Captur, Gabriella
Singh, Anvesha
Chin, Calvin
Dobson, Laura E.
Pica, Silvia
Loudon, Margaret
Malley, Tamir
Rigolli, Marzia
Foley, James R.J.
Bijsterveld, Petra
Law, Graham R.
Dweck, Marc R.
Myerson, Saul G.
McCann, Gerry P.
Prasad, Sanjay K.
Moon, James C.
Greenwood, John P.
Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title_full Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title_fullStr Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title_full_unstemmed Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title_short Myocardial Scar and Mortality in Severe Aortic Stenosis: Data From the BSCMR Valve Consortium
title_sort myocardial scar and mortality in severe aortic stenosis: data from the bscmr valve consortium
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221382/
https://www.ncbi.nlm.nih.gov/pubmed/30002099
http://dx.doi.org/10.1161/CIRCULATIONAHA.117.032839
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