Myocardial Scar and Mortality in Severe Aortic Stenosis
| Autor: | Musa, Tarique A., Treibel, Thomas A., Vassiliou, Vassiliou S., Captur, Gabriella, Singh, Anvesha, Chin, Calvin, Dobson, Laura E., Pica, Silvia, Loudon, Margaret, Malley, Tamir, Rigolli, Marzia, Foley, James R.J., Bijsterveld, Petra, Law, Graham R., Dweck, Marc R., Myerson, Saul G., McCann, Gerry P., Prasad, Sanjay K., Moon, James C., Greenwood, John P. |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
A300 Clinical Medicine Contrast Media Magnetic Resonance Imaging Cine Gadolinium Kaplan-Meier Estimate Severity of Illness Index Transcatheter Aortic Valve Replacement Cicatrix Original Research Articles magnetic resonance imaging Humans Longitudinal Studies Aged Proportional Hazards Models Aged 80 and over Myocardium Aortic Valve Stenosis Middle Aged mortality Treatment Outcome Echocardiography ComputingMethodologies_DOCUMENTANDTEXTPROCESSING Female |
| Zdroj: | Circulation |
| Popis: | Supplemental Digital Content is available in the text. Background: Aortic valve replacement (AVR) for aortic stenosis is timed primarily on the development of symptoms, but late surgery can result in irreversible myocardial dysfunction and additional risk. The aim of this study was to determine whether the presence of focal myocardial scar preoperatively was associated with long-term mortality. Methods: In a longitudinal observational outcome study, survival analysis was performed in patients with severe aortic stenosis listed for valve intervention at 6 UK cardiothoracic centers. Patients underwent preprocedural 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 3 patterns (none, infarct, or noninfarct patterns) and quantified with the full width at half-maximum method as percentage of the left ventricle. All-cause mortality and cardiovascular mortality were tracked for a minimum of 2 years. Results: Six hundred seventy-four patients with severe aortic stenosis (age, 75±14 years; 63% male; aortic valve area, 0.38±0.14 cm2/m2; mean gradient, 46±18 mm Hg; left ventricular ejection fraction, 61.0±16.7%) were included. Scar was present in 51% (18% infarct pattern, 33% noninfarct). Management was surgical AVR (n=399) or transcatheter AVR (n=275). During follow-up (median, 3.6 years), 145 patients (21.5%) died (52 after surgical AVR, 93 after transcatheter AVR). In multivariable analysis, the factors independently associated with all-cause mortality were age (hazard ratio [HR], 1.50; 95% CI, 1.11–2.04; P=0.009, scaled by epochs of 10 years), Society of Thoracic Surgeons 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% versus 12.9%; P |
| Databáze: | OpenAIRE |
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