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

Korean Circulation Journal 2014년 44권 5호 p.312 ~ p.319

박준범(Park Jun-Beom) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
장혁재(Chang Hyuk-Jae) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
최정호(Choi Jung-Ho) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
양필성(Yang Pil-Sung) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
이상은(Lee Sang-Eun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
허란(Heo Ran) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
신상훈(Shin Sang-Hoon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
조인정(Cho In-Jeong) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
김영진(Kim Young-Jin) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
심지영(Shim Chi-Young) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
홍그루(Hong Geu-Ru) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
정남식(Chung Nam-Sik) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology

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.

키워드

Cardiac magnetic resonance imaging, Echocardiography, Aortic stenosis, Late gadolinium enhancement
원문 및 링크아웃 정보
등재저널 정보
SCI(E) 학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
The absence of LGE is associated with favorable improvements in LV geometry and filling pressure; 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-).
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
DOI
KCD코드
ICD 03
건강보험코드