Abstract 16245: Can Two-Dimensional Speckle Tracking Imaging Detect the Myocardial Fibrosis in Aortic Stenosis Patients?
Introduction: Determining the appropriate timing of intervention is critical and clinically complex in the management of aortic stenosis (AS). An early intervention may be justified in case of subclinical systolic dysfunction in patients with preserved LVEF. Positive gadolinium delayed enhancement (GdDE) by MRI is a marker of myocardial fibrosis and reported to be a negative prognostic factor. The aim of this study was 1) to assess the myocardial fibrosis using GdDE in AS with preserved EF, and 2) to test the diagnostic value of longitudinal strain to detect myocardial fibrosis.
Methods: Thirty-nine patients with moderate or severe AS were prospectively enrolled. Previous myocardial infarction, presence of wall motion asynergy, greater than mild valvular regurgitation, any known cardiomyopathy, EF<50%, and age<65 were excluded. Patients had cardiac MRI and were assessed presence or absence of GdDE, and had comprehensive echocardiography examinations. Global longitudinal strain (GLS) and regional longitudinal strain were analyzed off-line using EchoPAC software.
Results: There was no significant difference in the frequency of GdDE according to the severity of AS (p=0.86)(Figure). When we compared between GdDE(+) and GdDE(-), there was no significant difference in GLS (p=0.54), but decrease in magnitude of regional longitudinal strain was observed in basal and mid inferior region in GdDE(+) patients (p=0.01, p=0.03 respectively)(Figure).
Conclusions: 1) Although myocardial fibrosis was detected in both moderate and severe AS, there was no difference in the frequency between the groups. 2) The presence or absence of fibrosis as determined by MRI did not influence the GLS, which may be related to underestimation of fibrosis burden by MRI or due to minimal impact on GLS from focal fibrosis. Further investigation including localization of fibrosis and regional longitudinal strain is needed to verify our results and elucidate the implications of positive GdDE.
Author Disclosures: M. Katayama: None. P. Panse: None. C. Kendall: None. D. Fortuin: None. J. Sweeney: None. M. Belohlavek: None. H. Chaliki: None.
- © 2016 by American Heart Association, Inc.