Independent predictor CMR of mortality in patient with surgical aortic stenosis

Abstract

Objectives: The purpose of this study was to evaluate the impact of focal fibrosis (FF) assessment by delayed-enhanced cardiac magnetic resonance (DE-CMR) on survival in patients with severe aortic stenosis (AS) treated by aortic valve replacement (AVR). Background: Prior studies have shown that DE-CMR predicts survival in severe aortic valve disease. However in context of curative surgery, FF impact is less known as well as influence of coronary status. Methods: The authors prospectively evaluated survival of 180 consecutive patients (118 males, age 72±9.5 years) with AVR undergoing DE-CMR. One hundred twenty four patients underwent isolated AVR, whereas 56 patients received associated coronary artery bypass graft (CABG). Results: Over the 3-year median follow-up, 21 patients died. Mean FF percentage was higher in patients with events versus those without (3.9±5.1 vs. 1.5±2.6, 0.001). Kaplan-Meier analyses revealed that higher degrees of FF were associated with worse long-term survival after AVR with or without associated CABG (chi-square = 3.58, p 0.05; chi-square = 4.15, p 0.04, respectively). On multivariable cox analysis, FF (hazard ratio [HR]: 1.12 (1.0-1.2), 95% confidence interval [CI]: 1.0 to 1.2, p < 0.004) and New York Heart Association functional class (HR: 2.0, 95% CI: 1.1 to 3.5, p < 0.01) were identified as strong independent determinants of poor prognosis. In patients with AS, there were 3 findings for FF distributed as follows between patients with events versus those without: no enhancement (67 vs. 42, p <0.02), infarct pattern (22 vs. 33, p =NS), and midwall enhancement (10 vs. 23, p =NS). However after exclusion of 67 patients with CAD history, prognostic value of FF was decreased (log rank=NS). Conclusions: With or without revascularization, presence of FF by DE-CMR is an independent predictor of mortality in patients AVR with AS. DE-CMR provides additional information in the evaluation of preoperative risk particularly for patients with CAD history.