Left Ventricular Hypertrophy in Aortic Stenosis: Early Cell and Matrix Regression 2 Months Post-Aortic Valve Replacement.

IF 6.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Circulation: Cardiovascular Imaging Pub Date : 2024-12-01 Epub Date: 2024-12-04 DOI:10.1161/CIRCIMAGING.124.017425

Jonathan Bennett, George D Thornton, Christian Nitsche, Francisco F Gama, Nikoo Aziminia, Uzma Gul, Abhishek Shetye, Peter Kellman, Rhodri H Davies, James C Moon, Thomas A Treibel

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Abstract

Background: In aortic stenosis, the myocardium responds with left ventricular hypertrophy, which is characterized by increased left ventricular mass due to cellular hypertrophy and extracellular matrix expansion. Following aortic valve replacement (AVR), left ventricular hypertrophy regression occurs, but early cellular and extracellular dynamics are unknown.

Methods: Patients with severe symptomatic aortic stenosis undergoing surgical or transcatheter AVR were prospectively recruited. Pre- and early post-AVR cardiac magnetic resonance imaging assessed left ventricular remodeling, global longitudinal strain, and T1 mapping to determine extracellular volume fraction and volume of cellular and extracellular compartments.

Results: In all, 39 patients (aged 71.4±9.8 years, male 79%, aortic valve peak velocity 4.4±0.5 m/s) underwent cardiac magnetic resonance before and at median 7.7 weeks post-AVR. Left ventricular mass index reduced significantly by 15.4% (P<0.001*), primarily driven by cellular compartment regression (18.7%, P<0.001*), with a smaller reduction in the extracellular compartment (7.2%, P<0.001*). This unbalanced regression led to an apparent increase in extracellular volume fraction (27.4±3.1% to 30.2±2.8%; P<0.001*). Although there was no significant change in global longitudinal strain post-AVR, an increase in extracellular volume fraction was associated with worsening of global longitudinal strain (Pearson r=0.41, P=0.01). Mode of intervention (transcatheter versus surgical) did not influence the above myocardial parameters post-AVR (all P>0.05). The asterisk in P values indicates a statistical significance of <0.05.

Conclusions: Within 8 weeks of AVR for aortic stenosis, substantial left ventricular hypertrophy regression occurs involving both cellular and extracellular compartments, demonstrating the early myocardial adaptability to afterload relief. Cellular compartment regression is greater than extracellular regression, leading to an apparent increase in extracellular volume fraction. Mode of intervention did not affect degree of reverse remodeling, indicating that both are effective at resulting beneficial changes post-AVR.

Registration: URL: https://www.isrctn.com; Unique identifier: NCT04627987.

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主动脉瓣置换术后2个月左心室肥厚：早期细胞和基质回归。

背景：主动脉瓣狭窄时，心肌反应为左心室肥厚，其特征是由于细胞肥厚和细胞外基质扩张导致左心室体积增加。主动脉瓣置换术（AVR）后，左心室肥厚消退，但早期细胞和细胞外动力学未知。方法：前瞻性招募接受手术或经导管AVR的严重症状性主动脉瓣狭窄患者。avr术前和术后早期心脏磁共振成像评估左心室重构、整体纵向应变和T1定位，以确定细胞外体积分数和细胞和细胞外室的体积。结果：39例患者（年龄71.4±9.8岁，男性79%，主动脉瓣峰值速度4.4±0.5 m/s）在avr前后7.7周接受了心脏磁共振检查。左室质量指数显著降低15.4% （PPPPP=0.01）。介入方式（经导管与手术）对avr后上述心肌参数无影响（P < 0.05）。结论：主动脉瓣狭窄AVR术后8周内，细胞室和细胞外室均发生了明显的左室肥厚消退，表明心肌对后负荷减轻具有早期适应性。细胞间室退化大于细胞外退化，导致细胞外体积分数明显增加。干预方式不影响逆转重塑的程度，表明两种干预方式对avr后的有益改变都是有效的。注册：网址：https://www.isrctn.com；唯一标识符：NCT04627987。

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来源期刊

Circulation: Cardiovascular Imaging 医学-核医学

CiteScore

6.30

自引率

2.70%

发文量

225

审稿时长

6-12 weeks

期刊介绍： Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others. Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.