title: Contrast-enhanced magnetic resonance imaging identifies focal regions of intramyocardial fibrosis in patients with severe aortic valve disease: Correlation with quantitative histopathology.
abstract: BACKGROUND
  Chronic aortic valve disease (AVD) is characterized by progressive accumulation of interstitial myocardial fibrosis (MF). However, assessment of MF accumulation has only been possible through histologic analyses of endomyocardial biopsies. We sought to evaluate contrast-enhanced magnetic resonance imaging (ce-MRI) as a noninvasive method to identify the presence of increased MF in patients with severe AVD.
  
  
  METHODS
  Seventy patients scheduled to undergo aortic valve replacement surgery were examined by cine and ce-MRI in a 1.5-T scanner. Cine images were used for the assessment of left ventricular (LV) volumes, mass, and function. Delayed-enhancement images were used to characterize the regions of MF. In addition, histologic analyses of myocardial samples obtained during aortic valve replacement surgery were used for direct quantification of interstitial MF. Ten additional subjects who died of noncardiac causes served as controls for the quantitative histologic analyses.
  
  
  RESULTS
  Interstitial MF determined by histopathologic analysis was higher in patients with AVD than in controls (2.7% +/- 2.0% vs 0.6% +/- 0.2%, P = .001). When compared with histopathologic results, ce-MRI demonstrated a sensitivity of 74%, a specificity of 81%, and an accuracy of 76% to identify AVD patients with increased interstitial MF. There was a significant inverse correlation between interstitial MF and LV ejection fraction (r = -0.67, P < .0001). Accordingly, patients with identifiable focal regions of MF by ce-MRI exhibited worse LV systolic function than those without MF (45% +/- 14% vs 65% +/- 14%, P < .0001).
  
  
  CONCLUSIONS
  Contrast-enhanced MRI allows for the noninvasive detection of focal regions of MF in patients with severe AVD. Moreover, patients with identifiable MF by ce-MRI exhibited worse LV functional parameters.
authors.affiliation: Heart Institute, University of São Paulo Medical School, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Nigri
authors.forename: Clerio F
authors.initials: CF
authors.lastname: Azevedo
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Vladimir
authors.initials: V
authors.lastname: Schraibman
authors.forename: Flavio
authors.initials: F
authors.lastname: Tarasoutchi
authors.forename: Pablo M
authors.initials: PM
authors.lastname: Pommerantzeff
authors.forename: Carlos Manuel
authors.initials: CM
authors.lastname: Brandão
authors.forename: Roney O
authors.initials: RO
authors.lastname: Sampaio
authors.forename: José R
authors.initials: JR
authors.lastname: Parga
authors.forename: Luiz F
authors.initials: LF
authors.lastname: Avila
authors.forename: Guilherme S
authors.initials: GS
authors.lastname: Spina
authors.forename: Max
authors.initials: M
authors.lastname: Grinberg
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000473:pathology*; D002908:Chronic Disease; D003287:Contrast Media; D005260:Female; D005355:Fibrosis / Q000175:diagnosis; D006349:Heart Valve Diseases / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*
chemical_list: D003287:Contrast Media