Abstract
BackgroundThe timing of surgery for aortic stenosis (AS) is imperfect, and the management of moderate AS and asymptomatic severe AS is still challenging. Myocardial fibrosis (MF) is the main pathological basis of cardiac decompensation in patients with AS and can be detected by cardiovascular magnetic resonance (CMR). The aim of this study was to evaluate the prognostic value of MF measured by CMR in patients with AS, which can provide a reference for the timing of aortic valve replacement (AVR).MethodsWe searched Medline, Embase, and Web of Science to include all studies that investigated the prognostic value of CMR in patients with AS. The search deadline is March 31, 2021. The pooled relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CI) of the biomarkers including late gadolinium enhancement (LGE), Native T1 or extracellular volume (ECV) were calculated to evaluate the prognostic value.Results13 studies and 2,430 patients with AS were included in this study, the mean or medium follow-up duration for each study was ranged from 6 to 67.2 months. Meta-analysis showed the presence of LGE was associated with an increased risk for all-cause mortality (pooled RR: 2.14, 95% CI: 1.67–2.74, P < 0.001), cardiac mortality (pooled RR: 3.50, 95% CI: 2.32–5.30, P < 0.001), and major adverse cardiovascular events (MACEs) (pooled RR: 1.649, 95% CI: 1.23–2.22, P = 0.001). Native T1 was significantly associated with MACEs (pooled RR: 2.23, 95% CI: 1.00–4.95; P = 0.049), and higher ECV was associated with a higher risk of cardiovascular events (pooled HR: 1.69, 95% CI: 1.11–2.58; P = 0.014).ConclusionThe use of CMR to detect MF has a good prognostic value in patients with AS. LGE, Native T1 and ECV measured by CMR can contribute to risk stratification of AS, thereby helping to optimize the timing of AVR.
Highlights
Aortic stenosis (AS) is the most common valvular diseases, and the prevalence in elderly is about 6%– 12.4% [1, 2]
Meta-analysis showed the presence of late gadolinium enhancement (LGE) was associated with an increased risk for all-cause mortality, cardiac mortality, and major adverse cardiovascular events (MACEs)
Native T1 was significantly associated with MACEs, and higher extracellular volume (ECV) was associated with a higher risk of cardiovascular events
Summary
Aortic stenosis (AS) is the most common valvular diseases, and the prevalence in elderly is about 6%– 12.4% [1, 2]. The early stage of AS is usually long and asymptomatic, once patients with AS develop clinical symptoms, the condition usually develops rapidly and is difficult to reverse. Since the elderly often develop other cardiovascular diseases at the same time, it is difficult to identify whether the symptoms are caused by AS. It is very important to find new effective markers to identify the degree of myocardial damage in patients with AS at an early stage. The timing of surgery for aortic stenosis (AS) is imperfect, and the management of moderate AS and asymptomatic severe AS is still challenging. The aim of this study was to evaluate the prognostic value of MF measured by CMR in patients with AS, which can provide a reference for the timing of aortic valve replacement (AVR)
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