Outcomes of myocardial fibrosis in patients undergoing transcatheter aortic valve replacement

Abstract

We sought to investigate the relevance of myocardial fibrosis, assessed by mid-wall fibrosis risk (MFR) score, with respect to left ventricular (LV) reverse remodelling following transcatheter aortic valve replacement (TAVR). Between January 2010 and March 2015, we enrolled 207 patients in whom baseline MFR, which includes age, sex, high-sensitivity cardiac troponin I, presence of strain pattern on electrocardiography, and peak aortic valve velocity, as well as one-year follow-up echocardiography was available. LV reverse remodelling was defined as a >10% reduction in LV end-diastolic volume index (LVEDVi). A higher MFR score (≥52) was associated with increased LVEDVi and with decreased LV ejection fraction as well as higher baseline NT-proBNP levels (p<0.05 for all). One year after the TAVR procedure, a higher MFR score was associated with a decreased probability of LV reverse remodelling (OR 0.33, 95% CI: 0.23-0.87; p=0.03), which was independent of baseline echocardiographic parameters and comorbidities. In contrast, there was no significant difference in five-year mortality between patients with lower and higher MFR scores (57.9% vs 60.5%, p=0.66). A higher MFR score is associated with reduced LV reverse remodelling at one-year follow-up, whereas the MFR score does not appear to correlate with long-term mortality after TAVR.