The association of left ventricular histologically verified myocardial fibrosis with pulmonary hypertension in severe aortic stenosis

Author:

Gumauskiene Birute1ORCID,Drebickaite Egle1,Pangonyte Dalia2,Vaskelyte Jolanta Justina12,Padervinskiene Lina3,Jakuska Povilas4,Budrikis Algimantas4ORCID,Ereminas Rokas4,Ereminiene Egle1

Affiliation:

1. Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

2. Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

3. Department of Radiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

4. Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania

Abstract

Objectives: To evaluate the association between histologically verified left ventricular (LV) myocardial fibrosis (MF) and its bio- and functional markers with pulmonary hypertension (PH) in severe aortic stenosis (AS). Methods: About 34 patients with isolated severe AS underwent 2D echocardiography, cardiac magnetic resonance (CMR) imaging, and plasma NT-proBNP evaluation before aortic valve replacement (AVR). LV measurements were analyzed by CMR and LV strain using feature tracking software (Medis Suite QStrain 2.0). Myocardial biopsy sampled at the time of AVR was assessed by a histomorphometric analysis. PH was defined as pulmonary artery systolic pressure (PASP) ⩾ 45 mm Hg. Results: Patients with severe AS and PH (mean PASP 53 ± 3.7 mm Hg) had higher extent of diffuse MF versus patients without PH (12 (10.4–12.7)% vs 6.6 (4.6–8.2)% (p = 0.00)). The extent of diffuse MF correlated with LV dilatation ( r = 0.7, p = 0.02), indices of LV dysfunction (lower ejection fraction ( r = −0.6, p < 0.001), global longitudinal ( r = −0.5, p = 0.02) and circumferential strain ( r = −0.5, p = 0.05), elevated NT-proBNP ( r = 0.5, p = 0.005) and elevated PASP ( r = 0.6, p < 0.001)). Histological MF > 10% (AUC 94.9%), LV global longitudinal strain > −15.5% (AUC 86.3%), and NT-proBNP > 2090 ng/l (AUC 85.1%) were independent predictors of PH in severe AS. Conclusions: The extent of diffuse myocardial fibrosis in combination with reduced longitudinal left ventricular strain and increased plasma levels of NT-proBNP relates to pulmonary hypertension in severe aortic stenosis.

Publisher

SAGE Publications

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Safety Research,Radiology, Nuclear Medicine and imaging,General Medicine

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