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. 2021 Mar 22:8:645693.
doi: 10.3389/fcvm.2021.645693. eCollection 2021.

Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement

Nina Rank  1 , Lukas Stoiber  1   2 , Mithal Nasser  1 , Radu Tanacli  1 , Christian Stehning  3 , Jan Knierim  2 , Felix Schoenrath  2   4 , Burkert Pieske  1   4   5 , Volkmar Falk  2   4   6   7 , Titus Kuehne  4   8 , Alexander Meyer  2   4 , Sebastian Kelle  1   4   5
Affiliations

Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement

Nina Rank et al. Front Cardiovasc Med. .

Abstract

Aims: Aortic valve replacement (AVR) may result in reverse cardiac remodeling. We aimed to assess long-term changes in the myocardium following AVR by Cardiac Magnetic Resonance Imaging (CMR). Methods: We prospectively observed the long-term left ventricular (LV) function and structure of 27 patients with AVR [n = 19 with aortic stenosis (AS); n = 8 with aortic regurgitation (AR)] by CMR. Patients underwent CMR before, as well as 1, 5, and 10 years after AVR. We evaluated clinical parameters, LV volumes, mass, geometry, ejection fraction (EF), global myocardial longitudinal strain (MyoGLS), global myocardial circular strain (MyoGCS), hemodynamic forces (HemForces), and Late Gadolinium Enhancement (LGE). Results: The median of LVMI, EDVI, and ESVI decreased in both groups. Patients with AR had higher initial values of EDVI and ESVI and showed a more prominent initial reduction. In AS, MyoGLS improved already after 1 year and remained constant afterward, whereas, in AR no improvement of MyoGLS was found. MyoGCS remained unchanged in the AS group but deteriorated in the AR group over 10 years. Ejection fraction (EF) was higher in AS patients compared to AR 10 years post-AVR. Late gadolinium enhancement (LGE) could be found more frequently in AS patients. Conclusion: CMR was well suited to investigate myocardial changes over a 10-year follow up period in patients with aortic valve disease. Regarding the long-term functional changes following AVR, patients with AR seemed to benefit less from AVR compared to AS patients. Fibrosis was more common in AS, but this did not reflect functional evolution in these patients. Close monitoring seems indispensable to avoid irreversible structural damage of the heart and to perform AVR at an appropriate stage.

Keywords: aortic regurgitation; aortic stenosis; aortic valve disease; aortic valve replacement; cardiac magnetic resonance imaging; ventricular remodeling.

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Conflict of interest statement

SK, AM, VF, and BP received support from the DZHK (German Center for Cardiovascular Research), Partner Site Berlin. SK was supported by Philips Healthcare and received speaker honoraria from Medis. CS is an employee of Philips Healthcare. VF has relavant (institutional) financial activities outside the summited work with following commercial entities: Medtronic GmbH, Biotronik SE & Co., Abbott GmbH & Co. KG, Boston Scientific, Edwards Lifesciences, Berlin Heart, Novartis Pharma GmbH, JOTEC GmbH and Zurich Heart in relation to educational grants (including travel support), fees for lectures and speeches, fees for professional consultation and research & study funds. AM declares the receipt of consulting and lecturing fees from Medtronic GmbH and Edwards Lifesciences Services GmbH, and consulting fees from Pfizer. FS declares the receipt of honoraria, consultancy fees or travel support from Medtronic GmbH, Biotronik SE & Co., Abbott GmbH & Co. KG, Sanofi S.A., Cardiorentis AG, Novartis Pharma GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Long-term development of the medians with interquartile ranges of clinical parameters. Red line – patients with aortic stenosis (AS). Blue line – patients with aortic regurgitation (AR). NYHA, New York Heart Association Functional Classification; SPC, subjective physical capacity.
Figure 2
Figure 2
Long-term development of the medians with interquartile ranges of anatomic parameters. Red line – patients with aortic stenosis (AS). Blue line – patients with aortic regurgitation (AR). Gray line – normal values (34). EDVI, end-diastolic volume index; ESVI, end-systolic volume index; LVMI, left ventricular mass index; SI, sphericity index.
Figure 3
Figure 3
Long-term development of the medians with interquartile ranges of functional parameters. Red line – patients with aortic stenosis (AS). Blue line – patients with aortic regurgitation (AR). Gray line – normal values (34) for EF, (35) for MyoGLS and MyoGCS, (25) for HemForces, (36) for ΔPm. EF, ejection fraction; MyoGLS, myocardial global longitudinal strain; MyoGCS, myocardial global circumferential strain; HemForces, hemodynamic forces; ΔPm, mean pressure gradient across the aortic valve.
Figure 4
Figure 4
End-diastolic short-axis view illustrating evolution of LV-mass in a patient with aortic stenosis (AS) over the 10-year follow up period. FU, follow up; LVMI, left ventricular mass index.
Figure 5
Figure 5
Three-chamber view illustrating evolution of LV end-diastolic volume in a patient with aortic regurgitation (AR) over the 10-year follow up period. One year after surgery a significant decrease of end-diastolic volume can be noted. However, over time this volume increases again. EDVI, End diastolic volume index; FU, follow up.
See this image and copyright information in PMC

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