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.

中文翻译：

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经组织学证实的左心室心肌纤维化与重度主动脉瓣狭窄患者肺动脉高压的相关性

目标：

评估组织学证实的左心室 (LV) 心肌纤维化 (MF) 及其生物和功能标志物与重度主动脉瓣狭窄 (AS) 肺动脉高压 (PH) 之间的关联。

方法：

大约 34 名孤立性严重 AS 患者在主动脉瓣置换术 (AVR) 前接受了二维超声心动图、心脏磁共振 (CMR) 成像和血浆 NT-proBNP 评估。使用特征跟踪软件 (Medis Suite QStrain 2.0) 通过 CMR 和 LV 应变分析 LV 测量值。通过组织形态学分析评估 AVR 时采集的心肌活检样本。PH 定义为肺动脉收缩压 (PASP)  45 mm Hg。

结果：

患有严重 AS 和 PH 的患者（平均 PASP 53 ± 3.7 mm Hg）与没有 PH 的患者相比具有更高程度的弥漫性 MF（12 (10.4–12.7)% 对 6.6 (4.6–8.2)% (p = 0.00)）。弥漫性 MF 的程度与 LV 扩张（r  = 0.7，p = 0.02）、LV 功能障碍指数（射血分数较低（r  = -0.6，p < 0.001）、全局纵向（r  = -0.5，p = 0.02）相关和圆周应变（r  = −0.5，p = 0.05），升高的 NT-proBNP（r  = 0.5，p = 0.005）和升高的 PASP（r  = 0.6，p < 0.001））。组织学 MF > 10% (AUC 94.9%)、LV 整体纵向应变 > −15.5% (AUC 86.3%) 和 NT-proBNP > 2090 ng/l (AUC 85.1%) 是严重 AS 中 PH 的独立预测因子。

结论：

弥漫性心肌纤维化的程度与纵向左心室应变降低和 NT-proBNP 血浆水平升高相结合，与严重主动脉瓣狭窄患者的肺动脉高压有关。