title: Echocardiographic and Histologic Correlations in Patients with Severe Aortic Stenosis: Influence of Overweight and Obesity.
abstract: BACKGROUND
  Severe aortic stenosis (AS), leads to pathological left ventricular remodeling that may worsen with concomitant overweight and obesity (OW/O).
  
  
  METHODS
  We aimed to prospectively analyze the impact of OW/O on ventricular remodeling in severe AS, by evaluating the percentage of intraendomyocardial fibrosis (PIEF) and the percentage of infiltrating intraendocardial lipid vacuoles (PIELV) and its relationship to global longitudinal strain (GLS) in patients with OW/O.
  
  
  RESULTS
  44 patients with severe AS were included, 13 non-obese (29%) and 31 OW/O (71%), all of them with left ventricular ejection fraction ≥ 55%. GLS was evaluated with 2D speckle tracking. During valve replacement, an endocardial biopsy was obtained, where PIEF and PIELV were analyzed. Patients with higher PIEF and PIELV had greater body mass index (p< 0.0001) and worse GLS (p< 0.0053). A GLS cut-off point < -14% had a sensitivity of 75%, and a specificity of 92.8% to detect important PIEF (AUC: 0.928, 95% confidence interval: 0.798-1.00). On multivariate analysis, OW/O and PIELV were independently associated to the PIEF, and OW/O and PIEF were independently associated to GLS. A high correlation between the amount of PIELV and PIEF were found.
  
  
  CONCLUSIONS
  Patients with severe AS and OW/O have greater PIEF and PIELV, suggesting more pathological remodeling. GLS is useful to detect subclinical myocardial injury and is potentially useful for endomyocardial fibrosis detection. The presence of higher PIELF may be a trigger factor for the development of intraendomyocardial fibrosis.
authors.affiliation: Department of Echocardiography, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Nydia
authors.initials: N
authors.lastname: Ávila-Vanzzini
authors.affiliation: Department of Echocardiography, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Fritche-Salazar
authors.affiliation: Department of Echocardiography, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Nelva Marina
authors.initials: NM
authors.lastname: Vázquez-Castro
authors.affiliation: Department of Echocardiography, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Pedro
authors.initials: P
authors.lastname: Rivera-Lara
authors.affiliation: Department of Molecular Biology, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Oscar
authors.initials: O
authors.lastname: Pérez-Méndez
authors.affiliation: Department of Surgery, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Humberto
authors.initials: H
authors.lastname: Martínez-Herrera
authors.affiliation: Department of Surgery, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Mario
authors.initials: M
authors.lastname: Gómez-Sánchez
authors.affiliation: Department of Pathology, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: Alberto
authors.initials: A
authors.lastname: Aranda-Frausto
authors.affiliation: Intermediate Care Unit, Médica Sur Clinical Foundation, Mexico City, Mexico.
authors.forename: Héctor
authors.initials: H
authors.lastname: Herrera-Bello
authors.affiliation: Department of Molecular Biology, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: María
authors.initials: M
authors.lastname: Luna-Luna
authors.affiliation: Department of Echocardiography, Ignacio Chávez National Cardiology Institute, Mexico City, Mexico.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Arias Godínez
keywords: Global longitudinal strain; Intraendomyocardial fibrosis; Overweight and obesity; Severe aortic stenosis