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 2014³â 44±Ç 5È£ p.312 ~ p.319
¹ÚÁعü(Park Jun-Beom) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology
ÀåÇõÀç(Chang Hyuk-Jae) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
ÃÖÁ¤È£(Choi Jung-Ho) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
¾çÇʼº(Yang Pil-Sung) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
ÀÌ»óÀº(Lee Sang-Eun) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
Çã¶õ(Heo Ran) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
½Å»óÈÆ(Shin Sang-Hoon) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
Á¶ÀÎÁ¤(Cho In-Jeong) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
±è¿µÁø(Kim Young-Jin) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
½ÉÁö¿µ(Shim Chi-Young) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
È«±×·ç(Hong Geu-Ru) - Yonsei University Health System Severance Cardiovascular Hospital Division of Cardiology and Radiology
Á¤³²½Ä(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¡¾8.7 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¡¾2.6 mm vs. 11.5¡¾2.0 mm, p=0.001, posterior; 14.3¡¾2.5 mm vs. 11.4¡¾1.6 mm, p<0.001), lower tissue Doppler image (TDIS¡¯, 4.4¡¾1.4 cm/s vs. 5.5¡¾1.2 cm/s, p=0.021; TDI E¡¯, 3.2¡¾0.9 cm/s vs. 4.8¡¾1.4 cm/s, p=0.002), and greater E/e¡¯ (21.8¡¾10.3 vs. 15.4¡¾6.3, 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¡¾5.0 mm vs. 45.8¡¾3.6 mm, p=0.027; 48.3¡¾5.0 mm vs. 46.5¡¾3.4 mm, p=0.019). Moreover, E/e¡¯ (at 12 months) showed further improved LV filling pressure (16.0¡¾6.6 vs. 12.3¡¾4.3, 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.
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Cardiac magnetic resonance imaging, Echocardiography, Aortic stenosis, Late gadolinium enhancement
KMID :
0368120140440050312
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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¡¾2.6 mm vs. 11.5¡¾2.0 mm, p=0.001, posterior; 14.3¡¾2.5 mm vs. 11.4¡¾1.6 mm, p<0.001), lower tissue Doppler image (TDIS¡¯, 4.4¡¾1.4 cm/s vs. 5.5¡¾1.2 cm/s, p=0.021; TDI E¡¯, 3.2¡¾0.9 cm/s vs. 4.8¡¾1.4 cm/s, p=0.002), and greater E/e¡¯ (21.8¡¾10.3 vs. 15.4¡¾6.3, p=0.066) than those without LGE (LGE-).