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

Musa, TA; Treibel, TA; Vassiliou, VS; Captur, G; Singh, A; Chin, C; Dobson, LE; ... Greenwood, JP; + view all (2018) Myocardial Scar and Mortality in Severe Aortic Stenosis: Data from the BSCMR Valve Consortium. Circulation , 138 (18) pp. 1935-1947. 10.1161/CIRCULATIONAHA.117.032839. Green open access

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Abstract

BACKGROUND: Aortic valve replacement (AVR) for aortic stenosis (AS) is timed primarily on the development of symptoms; but late surgery can result in irreversible myocardial dysfunction and additional risk. This study aimed to determine whether presence of focal myocardial scar pre-operatively was associated with long-term mortality. METHODS: In a longitudinal observational outcome study, survival analysis was performed in patients with severe AS listed for valve intervention at six UK cardiothoracic centers. Patients underwent pre-procedure 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 three patterns (none, infarct or non-infarct patterns) and quantified using the full-width-at-half-maximum method as percentage of the left ventricle. All-cause and cardiovascular mortality were tracked for a minimum of 2 years. RESULTS: 674 patients with severe AS (75±14years, 63% male; AV area 0.38±0.14cm2/m2; mean gradient 46±18mmHg, LVEF 61.0±16.7%) were included. Scar was present in 51% (18% infarct-pattern; 33% non-infarct). Management was surgical (SAVR, n=399) or transcatheter (TAVR, n=275). During follow-up (median 3.6 years), 145 (21.5%) died (52 post-SAVR, 93 post-TAVR). At multivariable analysis, the factors independently associated with all-cause mortality were age (HR 1.50, 95%CI: 1.11-2.04, p=0.009; scaled by epochs of 10 years), STS 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% vs 12.9%; p<0.001) and cardiovascular mortality (15.0% vs 4.8%; p<0.001), regardless of intervention (TAVR p=0.002, SAVR p=0.026 [all-cause mortality]). Every 1% increase in LV 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 AS, late gadolinium enhancement on cardiovascular MR was independently associated with mortality; its presence being associated with a 2-fold higher late mortality.

Type: Article
Title: Myocardial Scar and Mortality in Severe Aortic Stenosis: Data from the BSCMR Valve Consortium
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1161/CIRCULATIONAHA.117.032839
Publisher version: https://doi.org/10.1161/CIRCULATIONAHA.117.032839
Language: English
Additional information: © 2018 Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDervis License (http://creativecommons.org/licenses/by-nc-nd/3.0/).
Keywords: scar, cardiovascular magnetic resonance, aortic stenosis, mortality
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10052467
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