Myocardial scar and remodelling predict long-term mortality in severe aortic stenosis beyond 10 years
George Thornton, Vassilios S. Vassiliou, Tarique A Musa, Nikoo Aziminia, Neil Craig, Abhishek Dattani, Rhodri Davies, Gabriella Captur, James Moon, Marc R. Dweck, Saul Myerson, Sanjay Prasad, Gerry P McCann, John P. Greenwood, Anvesha Singh, Thomas A. Treibel, Nikoo Aziminia, Petra Bijsterveld, Gabriella Captur, Neil Craig, Abhishek Dattani, Rhodri Davies, Laura E Dobson, Marc R. Dweck, James Foley, John P. Greenwood, Graham Law, Margaret Loudon, Tamir Malley, Gerry P McCann, Saul Myerson, James Moon, Tarique A Musa, Silvia Pica, Sanjay Prasad, Marzia Rigolli, Anvesha Singh, Lydia Sulaiman, George Thornton, Thomas A. Treibel, Vassilios S. Vassiliou
Abstract
<p>Aortic stenosis (AS) is characterized by the narrowing of the aortic valve and compensatory myocardial remodelling.1 However, ultimately the left ventricle decompensates, leading to heart failure and death, and intervention is advised for severe AS accompanied by either symptoms or left ventricular (LV) dysfunction.2 Yet, over half of patients receiving aortic valve replacement (AVR) have irreversible myocardial scarring.3 Our multi-centre UK consortium linked pre-operative myocardial scarring, detected by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) with increased all-cause and cardiovascular (CV) mortality, regardless of intervention type, after a median of 3.5 years.4 With the integration of machine learning for CMR analysis, we achieve 40% greater precision than human assessment, potentially uncovering patterns obscured by human variability.5 We now examine whether the association of myocardial scar with mortality persists over longer-term follow-up.</p>