New Markers of Aortic Stenosis Define Asymptomatic Patients

Asymptomatic aortic stenosis has been keeping us in tense stillness. However, there are new markers capable of identifying patients that might benefit from earlier intervention. In this regard, cardiovascular magnetic resonance (CMR) has been gaining its well-deserved place in cardiology and now more specifically in aortic stenosis. 

Nuevos marcadores de daño en estenosis aórtica que definen pacientes asintomáticos

This study sought to validate CMR markers of prognostic value to aortic stenosis and its thresholds to predict mortality.   

The study prospectively included 799 aortic stenosis patients (n=440 in the derivation cohort and n=359 in the validation cohort) from 13 international centers followed up for nearly 4 years. 

CMR was done shortly before surgical or transcatheter aortic valve replacement (AVR). A forest model was used with 29 variables (13 CMR) capable of predicting mortality and post procedure events. 

There were 52 deaths in the derivation cohort and 51 deaths in the validation cohort. The 4 CMR markers with most predictive power were extracellular volume fraction, late gadolinium enhancement, indexed left ventricular end-diastolic volume, and right ventricular ejection fraction.  

Mortality increased significantly both in the global cohort and among asymptomatic patients when extracellular volume fraction exceeded 27%. 2% of late gadolinium enhancement showed persistent high risk. 


Read also: Anticoagulation with Heparin in Non-Critical COVID-19.


As regards indexed left ventricular end-diastolic volume, increased mortality was also observed at both extremes. High (>80 ml/m2) and low volumes (<55 ml/m2) were mortality predictors.  

There was also increased mortality with high (>80%) and low (≤50%) right ventricular ejection fraction (>80% y <50%).

Predictability improved even further when these 4 markers were combined with clinical factors 


Read also: Heparin Anticoagulation in Critically Ill COVID-19 Patients: Results that Differ from the Rest.


The prognostic thresholds and risk stratification by CMR variables were reproduced in the validation cohort. 

Conclusion

Myocardial fibrosis and biventricular remodeling are the best prognostic factors in patients with aortic stenosis. We should highlight its non-linear association with mortality. 

CMR has the potential to optimize decision making in treating patients with aortic stenosis. 

Original Title: Markers of Myocardial Damage Predict Mortality in Patients With Aortic Stenosis.

Reference: Soongu Kwak et al. J Am Coll Cardiol. 2021 Aug 10;78(6):545-558. doi: 10.1016/j.jacc.2021.05.047.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

Prospective Analysis of the Feasibility of the PASCAL System for Transcatheter Mitral Repair: OneForAll Registry

Courtesy of Dr. Juan Manuel Pérez. Mitral transcatheter edge-to-edge repair (M-TEER) is an effective option for patients with severe mitral regurgitation who are at high...

Left Bundle Branch Block after TAVR: What Is Its Impact?

Courtesy of Dr. Juan Manuel Pérez. Left bundle branch block (LBBB) is a common complication following transcatheter aortic valve replacement (TAVR), which can be either...

Multicenter Experience with 3D Intracardiac Echocardiography for Guiding Interventional Cardiac Procedures

Courtesy of Dr. Juan Manuel Pérez. Imaging techniques play a fundamental role in interventional cardiac procedures. Intracardiac echocardiography (ICE) appears as an alternative to transesophageal...

Pathology of Self-Expanding Transcatheter Aortic Bioprostheses and Hypoattenuated Leaflet Thickening

Courtesy of Dr. Juan Manuel Pérez. Despite the available long term followup data on of transcatheter aortic valve replacement (TAVR), bioprosthesis durability continues under debate....

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

ACC 2025 | FAME 3: FFR Guided PCI vs CABG 5 Year Outcomes.

Earlier studies comparing percutaneous coronary intervention (PCI) vs coronary artery bypass graft (CABG) have shown fewer events at long term for the surgical strategy.  However,...

ACC 2025 | API-CAT: Reduced vs. Full Dose Extended Anticoagulation in Patients with Cancer Related VTE

The risk of cancer related recurrent venous thromboembolism (VTE) will drop over time, while bleeding risk will persist. At present, it is recommended we...

STRIDE: Semaglutide in Patients with Peripheral Arterial Disease and Type II Diabetes

Peripheral arterial disease (PAD) is a severe complication in patients with type II diabetes, primarily affecting peripheral vessels, especially below-the-knee (BTK) arteries. This condition...