Korean Circ J.  2014 Sep;44(5):312-319. 10.4070/kcj.2014.44.5.312.

Late Gadolinium Enhancement in Cardiac MRI in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Is Related to Attenuated Improvement of Left Ventricular Geometry and Filling Pressure after Aortic Valve Replacement

• Park J
• Chang HJ
• Choi JH
• Yang PS
• Lee SE
• Heo R
• Shin S
• Cho IJ
• Kim YJ
• Shim CY
• Hong GR
• Chung N

• KMID: 2223870
• DOI: http://doi.org/10.4070/kcj.2014.44.5.312

Abstract

BACKGROUND AND OBJECTIVES
We investigated echocardiographic predictors: left ventricular (LV) geometric changes following aortic valve replacement (AVR) according to the late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with severe aortic stenosis (AS) and preserved LV systolic function.
SUBJECTS AND METHODS
We analyzed 41 patients (24 males, 63.1+/-8.7 years) with preserved LV systolic function who were scheduled to undergo AVR for severe AS. All patients were examined with transthoracic echocardiography (TTE), CMR before and after AVR (in the hospital) and serial TTEs (at 6 and 12 months) were repeated.
RESULTS
The group with LGE (LGE+) showed greater wall thickness (septum, 14.3+/-2.6 mm vs. 11.5+/-2.0 mm, p=0.001, posterior; 14.3+/-2.5 mm vs. 11.4+/-1.6 mm, p<0.001), lower tissue Doppler image (TDIS', 4.4+/-1.4 cm/s vs. 5.5+/-1.2 cm/s, p=0.021; TDI E', 3.2+/-0.9 cm/s vs. 4.8+/-1.4 cm/s, p=0.002), and greater E/e' (21.8+/-10.3 vs. 15.4+/-6.3, p=0.066) than those without LGE (LGE-). Multivariate analysis show that TDI e' (odds ratio=0.078, 95% confidence interval=0.007-0.888, p=0.040) was an independent determinant of LGE+. In an analysis of the 6- and 12-month follow-up compared with pre-AVR, LGE- showed decreased LV end-diastolic diameter (48.3+/-5.0 mm vs. 45.8+/-3.6 mm, p=0.027; 48.3+/-5.0 mm vs. 46.5+/-3.4 mm, p=0.019). Moreover, E/e' (at 12 months) showed further improved LV filling pressure (16.0+/-6.6 vs. 12.3+/-4.3, p=0.001) compared with pre-AVR. However, LGE+ showed no significant improvement.
CONCLUSION
The absence of LGE is associated with favorable improvements in LV geometry and filling pressure. TDI E' is an independent determinant of LGE in patients with severe AS and preserved LV systolic function.

Keyword

Cardiac magnetic resonance imaging; Echocardiography; Aortic stenosis; Late gadolinium enhancement

MeSH Terms

Aortic Valve Stenosis*
Aortic Valve*
Echocardiography
Follow-Up Studies
Gadolinium*
Humans
Magnetic Resonance Imaging*
Male
Multivariate Analysis
Gadolinium

Figure

• 

  Fig. 1 Evaluation of the progress of patients enrolled in the study. TTE: transthoracic echocardiography, CMR: cardiac magnetic resonance image, CAG: coronary angiography, AVR: aortic valve replacement, f/u: follow up, EF: ejection fraction.

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  Fig. 2 The myocardium of the LV was evaluated in short axis view, and divided into base level (6 segments), mid level (6 segments), and apex (4 segments). The entire myocardium of the LV was analyzed as a total of 16 segments. LV: left ventricular, LAD: left anterior descending, LCX: left circumplex artery, RCA: right coronary artery.

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  Fig. 3 Bull's eye map image regarding late gadolinium enhancement (left: short axis, right: long axis).

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  Fig. 4 Change in left ventricular geometry after aortic valve replacement. Groups 1, 2, 3, and 4: pre-OP, post-OP, 6 months post-OP, and 12 months post-OP, respectively. Error bars: 95% confidence interval. *p<0.05. LGE: late gadolinium enhancement, LVEDD: left ventricle end diastolic diameter, LVMI: left ventricle mass index.

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  Fig. 5 Change in left ventricular systolic function and filling pressure after aortic valve replacement. Group 1, 2, 3, and 4: pre-OP, post OP, 6 months post-OP, and 12 months post-OP, respectively. Error bars: 95% confidence interval. *p<0.05. LGE: late gadolinium enhancement, LVEF: left ventricle ejection fraction.

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