The effect of myocardial fibrosis on ventricular remodeling following valve replacement for severe aortic stenosis. A CMR study comparing transcatheter aortic valve implantation and surgical aortic valve replacement

Abstract

Summary Myocardial fibrosis (MF) that occurs in aortic stenosis (AS) has been shown to be associated with a poor prognostic outcome post surgical aortic valve replacement (SAVR) but not in the high risk patients suitable for Transcatheter aortic valve implantation (TAVI). Using the technique of late-gadolinium enhancement we have shown that MF regresses post-TAVI but not postSAVR, and that ejection fraction rather than MF is the independent predictor of reverse remodeling. Background Myocardial Fibrosis (MF) occurs as part of the remodelling process in left ventricular hypertrophy associated with severe aortic stenosis (AS). MF has been shown to be associated with reduced left ventricle (LV) ejection fraction and poor prognosis following surgical aortic valve replacement (SAVR). Transcatheter aortic valve implantation (TAVI) has become a standard procedure for the treatment of severe aortic stenosis in high risk or inoperable patients. The significance of MF in this high-risk patient population has to date not been assessed. We aimed to assess the baseline burden of MF, its change following TAVI and SAVR, and its influence on LV reverse remodeling. Methods