Are We Treating Severe Aortic Stenosis Too Late?

Myocardial fibrosis seen on cardiac magnetic resonance is associated with late mortality after aortic valve replacement.

Current guidelines do not recommend aortic valve replacement (AVR) for asymptomatic patients with severe aortic stenosis (AS) and preserved left ventricular (LV) function. However, subclinical adverse remodeling can precede the development of symptoms and LV dysfunction. For this reason, investigators performed cardiac magnetic resonance (CMR) in 674 patients who had severe AS and were scheduled for surgical or transcatheter AVR.

Myocardial fibrosis (scar) demonstrated by late gadolinium enhancement (LGE) on CMR was common (51%); these patients were more likely than patients without LGE to be male and to have myocardial infarction histories, greater LV mass, lower ejection fraction, and larger LV end diastolic volume index. In a median follo…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)