BACKGROUND Patients with moderate or asymptomatic severe aortic stenosis (AS) are at risk of cardiovascular events. OBJECTIVES The authors investigated the utility of cardiac magnetic resonance (CMR) to identify drivers of outcome in patients with moderate or asymptomatic severe AS. METHODS A prospective, international, multicenter cohort (n = 457) of patients with moderate (aortic valve area [AVA]: 1.0-1.5 cm2) or asymptomatic severe AS (AVA ≤1.0 cm2 and NYHA functional class I-II) patients underwent CMR. Diffuse interstitial fibrosis and scar in the myocardium were analyzed with extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). The outcome was a composite of mortality and heart failure admission. RESULTS Median ECV% was 26.6% (IQR: 24.4%-29.9%), and LGE was present in 31.5% (median 0.8%; IQR: 0.1%-1.7%). Greater AS severity was associated with greater left ventricular mass and diastolic dysfunction, but not with ECV% or LGE. During a median 5.7 years of follow-up, 83 events occurred. Patients with events had higher ECV% (median ECV% 26.3% vs 28.2%; P = 0.003). Patients in the highest ECV% tertiles (ECV% >28.6%) had worse outcomes both in the entire cohort and in those with NYHA functional class I moderate or severe AS, and ECV% was independently associated with outcome (adjusted HR: 1.05; P = 0.039). The ECV% had significant incremental prognostic value when added to parameters of AS severity and cardiac function, comorbidities, aortic valve replacement, and LGE (P < 0.05). CONCLUSIONS Increased diffuse interstitial fibrosis of the myocardium is associated with poor outcomes in patients with moderate and asymptomatic severe AS and can help identify those who require closer surveillance for adverse outcomes.

中文翻译：

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心肌弥漫性间质纤维化可预测中度和无症状重度主动脉瓣狭窄的结果。


背景 中度或无症状的重度主动脉瓣狭窄（AS）患者存在心血管事件的风险。目的 作者研究了心脏磁共振 (CMR) 在确定中度或无症状重度 AS 患者预后驱动因素方面的效用。方法 对中度（主动脉瓣面积 [AVA]：1.0-1.5 cm2）或无症状重度 AS（AVA ≤1.0 cm2 且 NYHA 功能分级 I-II）患者进行前瞻性、国际、多中心队列（n = 457）接受 CMR 。通过细胞外体积分数 (ECV%) 和晚期钆增强 (LGE) 分析心肌中的弥漫性间质纤维化和疤痕。结果是死亡率和心力衰竭入院的综合结果。结果 中位 ECV% 为 26.6%（IQR：24.4%-29.9%），LGE 占 31.5%（中位 0.8%；IQR：0.1%-1.7%）。 AS 严重程度越高，左心室质量和舒张功能障碍越大，但与 ECV% 或 LGE 无关。在平均 5.7 年的随访期间，发生了 83 起事件。发生事件的患者具有较高的 ECV%（中位 ECV% 26.3% vs 28.2%；P = 0.003）。在整个队列中以及 NYHA 功能 I 级中度或重度 AS 患者中，处于最高 ECV% 三分位 (ECV% >28.6%) 的患者结局较差，并且 ECV% 与结局独立相关（调整后的 HR：1.05） ; P = 0.039）。当添加到 AS 严重程度和心功能、合并症、主动脉瓣置换术和 LGE 参数时，ECV% 具有显着的增量预后价值 (P < 0.05)。结论 心肌弥漫性间质纤维化的增加与中度和无症状重度 AS 患者的不良预后相关，有助于识别需要更密切监测不良预后的患者。