Abstract 18091: Impact of Late Gadolinium Enhancement With Cardiac Magnetic Resonance on Mortality in Moderate to Severe Aortic Stenosis
Objective: Our aim is to examine the association between late gadolinium enhancement (LGE) detected by cardiac magnetic resonance imaging (CMR) and mortality in patients with moderate or severe aortic stenosis (AS).
Methods: Patients presenting for CMR assessment of aortic stenosis were prospectively enrolled into our CMR registry. This study evaluated 276 consecutive patients with moderate or severe AS who underwent delayed enhancement (DE-CMR) from June 2009 - October 2013. Exclusion criteria were moderate or severe aortic insufficiency and aortic valve replacement before CMR. Patients were categorized into LGE 0%, LGE 1-5% and LGE>5%. Median follow up was 14 months (IQR 2-27 months).
Results: The cohort had a mean age of 70±14 years with 58% (160) men, of which 51% had severe AS. Mean LVEF was 60±19%. LGE was evident in 56% (155/276 patients) of which 105 (68%) had LGE of 1-5% and 50 (32%) had LGE > 5%. LGE pattern was consistent with CAD in 68 patients whereas 87 patients had non-CAD pattern. Patients in the LGE 1-5% and >5% group were older (p=0.02), had more males (p<0.001), and a higher prevalence of diabetes mellitus (p=0.004), hypertension (p=0.033), smoking (p=0.037), bicuspid aortic valve (p=0.013), lower LVEF (p<0.001), higher LVEDV (p<0.001), higher LVESV (p<0.001) and higher LV mass (p<0.001). Subsequent aortic valve replacement was performed in 48% (133 patients). During the follow up period, death occurred in 52 patients (19%). On Kaplan Meier analysis, patients with higher LGE had increased mortality (unadjusted log-rank p=0.005). LGE > 5% was significantly associated with death. After adjusting for age, LVEF, LV mass, CAD, diabetes mellitus and subsequent AVR, the association between LGE >5% and mortality remained significant (HR 2.34, p=0.047).
Conclusions: LGE detected by DE-CMR is associated with higher long term mortality in patients with moderate or severe AS. Our findings suggest a potential role of DE-CMR in risk stratification of these patients.
Author Disclosures: R. Adigun: None. K. Chaikriangkrai: None. M. Ghosn: None. S.H. Little: None. W.A. Zoghbi: None. F. Nabi: None. D.J. Shah: None.
- © 2014 by American Heart Association, Inc.