Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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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, Junbeom (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Chang, Hyuk-Jae (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Choi, Jung-Ho (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Yang, Pil-Sung (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Lee, Sang-Eun (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Heo, Ran (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Shin, Sanghoon (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Cho, In-Jeong (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Kim, Young-Jin (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Shim, Chi Young (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Hong, Geu-Ru (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System) ;
  • Chung, Namsik (Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System)
  • Received : 2014.02.27
  • Accepted : 2014.07.08
  • Published : 2014.05.30
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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, $63.1{\pm}8.7$ 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, $14.3{\pm}2.6mm$ vs. $11.5{\pm}2.0mm$, p=0.001, posterior; $14.3{\pm}2.5mm$ vs. $11.4{\pm}1.6mm$, p<0.001), lower tissue Doppler image (TDIS', $4.4{\pm}1.4cm/s$ vs. $5.5{\pm}1.2cm/s$, p=0.021; TDI E', $3.2{\pm}0.9cm/s$ vs. $4.8{\pm}1.4cm/s$, p=0.002), and greater E/e' ($21.8{\pm}10.3$ vs. $15.4{\pm}6.3$, 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 ($48.3{\pm}5.0mm$ vs. $45.8{\pm}3.6mm$, p=0.027; $48.3{\pm}5.0mm$ vs. $46.5{\pm}3.4mm$, p=0.019). Moreover, E/e' (at 12 months) showed further improved LV filling pressure ($16.0{\pm}6.6$ vs. $12.3{\pm}4.3$, 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.

Keywords

Acknowledgement

Grant : Development of Multi-modality Imaging and 3D Simulation-Based Integrative Diagnosis-Treatment Support Software System for Cardiovascular Diseases

Supported by : MSIP/KEIT

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