Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2024 Dec;17(12):e017425.
doi: 10.1161/CIRCIMAGING.124.017425. Epub 2024 Dec 4.

Left Ventricular Hypertrophy in Aortic Stenosis: Early Cell and Matrix Regression 2 Months Post-Aortic Valve Replacement

Jonathan Bennett  1   2 , George D Thornton  1   2 , Christian Nitsche  1   2   3 , Francisco F Gama  2 , Nikoo Aziminia  1   2 , Uzma Gul  2 , Abhishek Shetye  2 , Peter Kellman  4 , Rhodri H Davies  1   2 , James C Moon  1   2 , Thomas A Treibel  1   2 ; Barts Valve and Imaging Group
Collaborators, Affiliations
Observational Study

Left Ventricular Hypertrophy in Aortic Stenosis: Early Cell and Matrix Regression 2 Months Post-Aortic Valve Replacement

Jonathan Bennett et al. Circ Cardiovasc Imaging. 2024 Dec.

Abstract

Background: In aortic stenosis, the myocardium responds with left ventricular hypertrophy, which is characterized by increased left ventricular mass due to cellular hypertrophy and extracellular matrix expansion. Following aortic valve replacement (AVR), left ventricular hypertrophy regression occurs, but early cellular and extracellular dynamics are unknown.

Methods: Patients with severe symptomatic aortic stenosis undergoing surgical or transcatheter AVR were prospectively recruited. Pre- and early post-AVR cardiac magnetic resonance imaging assessed left ventricular remodeling, global longitudinal strain, and T1 mapping to determine extracellular volume fraction and volume of cellular and extracellular compartments.

Results: In all, 39 patients (aged 71.4±9.8 years, male 79%, aortic valve peak velocity 4.4±0.5 m/s) underwent cardiac magnetic resonance before and at median 7.7 weeks post-AVR. Left ventricular mass index reduced significantly by 15.4% (P<0.001*), primarily driven by cellular compartment regression (18.7%, P<0.001*), with a smaller reduction in the extracellular compartment (7.2%, P<0.001*). This unbalanced regression led to an apparent increase in extracellular volume fraction (27.4±3.1% to 30.2±2.8%; P<0.001*). Although there was no significant change in global longitudinal strain post-AVR, an increase in extracellular volume fraction was associated with worsening of global longitudinal strain (Pearson r=0.41, P=0.01). Mode of intervention (transcatheter versus surgical) did not influence the above myocardial parameters post-AVR (all P>0.05). The asterisk in P values indicates a statistical significance of <0.05.

Conclusions: Within 8 weeks of AVR for aortic stenosis, substantial left ventricular hypertrophy regression occurs involving both cellular and extracellular compartments, demonstrating the early myocardial adaptability to afterload relief. Cellular compartment regression is greater than extracellular regression, leading to an apparent increase in extracellular volume fraction. Mode of intervention did not affect degree of reverse remodeling, indicating that both are effective at resulting beneficial changes post-AVR.

Registration: URL: https://www.isrctn.com; Unique identifier: NCT04627987.

Keywords: aortic valve; aortic valve stenosis; hypertrophy, left ventricular; magnetic resonance imaging; myocardium.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Graphical representation of cardiovascular magnetic resonance protocol. AI indicates artificial intelligence; ECV%, extracellular volume fraction; and MOLLI, modified look-locker inversion.
Figure 2.
Figure 2.
Raincloud plots comparing pre- and post-aortic valve replacement (AVR) left ventricular remodelling and fibrosis. There is significant reduction in left ventricular mass index (LVMi; A), increase in extracellular volume fraction (ECV%; B), and reductions in cellular volume index (CellVi; C), and extracellular volume index (ECVi; D) post-AVR.
Figure 3.
Figure 3.
Exemplar case of changes in left ventricular remodeling and tissue changes pre- and post-aortic valve replacement (AVR) in a patient undergoing transcatheter AVR (TAVR). AS indicates aortic stenosis; CellVi, cellular volume index; ECV%, extracellular volume fraction; ECVi, extracellular volume index; LGE, late gadolinium enhancement; and LVMi, left ventricular mass index.
Figure 4.
Figure 4.
Scatter graphs for associations pre- and post-aortic valve replacement. There is significant positive association between change in extracellular volume fraction and global longitudinal strain (GLS; A), no significant associations detected for change in cellular volume fraction (B), left ventricular mass index (C), or extracellular volume index (D).
See this image and copyright information in PMC

Comment in

References

    1. de Haas HJ, Arbustini E, Fuster V, Kramer CM, Narula J. Molecular imaging of the cardiac extracellular matrix. Circ Res. 2014;114:903–915. doi: 10.1161/CIRCRESAHA.113.302680 - PubMed
    1. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, Sheikh A, López B, González A, Manisty C, et al. . Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. 2018;71:860–871. doi: 10.1016/j.jacc.2017.12.035 - PMC - PubMed
    1. Treibel TA, López B, González A, Menacho K, Schofield RS, Ravassa S, Fontana M, White SK, DiSalvo C, Roberts N, et al. . Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients. Eur Heart J. 2018;39:699–709. doi: 10.1093/eurheartj/ehx353 - PMC - PubMed
    1. Beach JM, Mihaljevic T, Rajeswaran J, Marwick T, Edwards ST, Nowicki ER, Thomas J, Svensson LG, Griffin B, Gillinov AM, et al. . Ventricular hypertrophy and left atrial dilatation persist and are associated with reduced survival after valve replacement for aortic stenosis. J Thorac Cardiovasc Surg. 2014;147:362–369.e8. doi: 10.1016/j.jtcvs.2012.12.016 - PubMed
    1. Gaudino M, Alessandrini F, Glieca F, Luciani N, Cellini C, Pragliola C, Morelli M, Canosa C, Nasso G, Possati G. Survival after aortic valve replacement for aortic stenosis: does left ventricular mass regression have a clinical correlate? Eur Heart J. 2005;26:51–57. doi: 10.1093/eurheartj/ehi012 - PubMed

Publication types

MeSH terms

Associated data