Prognostic implications of fibrosis in low risk aortic stenosis patients

• Tipo: Artigo em Revista Científica Nacional
• Data: 2022

Autores

Gavina C (Autor) FMUP; Falcao Pires, I (Autor) FMUP; Santos-Faria J. (Autor) Outra; Marinho B. (Autor) FMUP; Almeida J. (Autor) Outra; Rodrigues J. (Autor) Outra; Pinho P. (Autor) Outra; Rocha-Gonçalves F. (Autor) Outra; Leite-Moreira AF (Autor) FMUP

Revista

Título: Revista Portuguesa de Cardiologia

ISSN: 0870-2551

Editora: Sociedade Portuguesa De Cardiologia

Indexação

ISI Web of Knowledge - 2 Citações

Scopus - 4 Citações

Outras Informações

ID Authenticus: P-00W-57N

DOI: 10.1016/j.repc.2021.02.017

Abstract (EN): Introduction and objectives: Among patients with aortic stenosis (AS), interstitial fibrosis has been associated with progression to heart failure and is a marker of poorer prognosis. We aimed to assess the impact of myocardial fibrosis on clinical events after aortic valve replacement (AVR) in low risk, severe AS. Methods: We prospectively followed 56 severe AS patients with ejection fraction >40%, who underwent AVR with simultaneous myocardial biopsies and collagen volume fraction (CVF) determination. Baseline and follow-up echocardiographic parameters were assessed. Outcomes were all-cause death and the combined endpoint of all-cause death or non-fatal cardiovascular hospitalization. Results: Patients were predominantly women (67.9%) and mean age was 66±12 years. At follow-up, there was a significant decrease in transaortic gradients and wall stress, as well as regression in indexed LV mass. Patients who suffered a fatal event or the combined endpoint had a higher degree of fibrosis (27.1±20.7% vs. 15.4±11.8%, p=0.035; 24.0±18.2% vs. 15.3±12.0%, p=0.038, respectively). Patients with CVF¿15.4% had higher rates of all-cause death (37.5% vs. 97.0%, p=0.001) and lower survival free of the combined endpoint of all-cause death or non-fatal cardiovascular hospitalization (0% vs. 91.2%, p<0.001). CVF was the only independent predictor of all-cause death (hazard ratio (HR) 1.88; 95% confidence interval (CI): 1.08-3.29 for each 10% increase; p=0.026) and all-cause death or cardiovascular hospitalization (HR 1.73; 95% CI: 1.03-2.911 for each 10% increase; p=0.038). Conclusions: In low risk AS patients, higher levels of fibrosis are independent predictors of all-cause death and the composite of all-cause death or non-fatal cardiovascular hospitalization. Further advances in anti-fibrotic therapies in AS are needed.

Idioma: Inglês

Tipo (Avaliação Docente): Científica

Nº de páginas: 11