title: Differences in Aortic Valve and Left Ventricular Parameters Related to the Severity of Myocardial Fibrosis in Patients with Severe Aortic Valve Stenosis.
abstract: OBJECTIVE
  This study investigated the morphological and functional characteristics of the aortic valve and the left ventricular (LV) systolic functional parameters and myocardial mass related to the severity of myocardial fibrosis (MF) in patients with severe aortic valve stenosis (AS).
  
  
  METHODS
  We retrospectively enrolled 81 patients (48 men; mean age: 59±12 years) with severe AS who underwent transthoracic echocardiography (TTE), cardiac computed tomography (CCT), and cardiovascular magnetic resonance (CMR) within 1 month and subsequent aortic valve surgery. Degree of MF was determined on delayed contrast-enhanced CMR with visual sub-segmental analysis-based quantification and was classified into three groups (no, mild, and severe) for identifying the differences in LV function and characteristics of the aortic valve. One-way ANOVA, Chi-square test or Fisher's exact test were used to compare variables of the three groups. Univariate multinomial logistic regression analysis was performed to determine the association between the severity of MF and variables on imaging modalities.
  
  
  RESULTS
  Of 81 patients, 34 (42%) had MF (mild, n = 18; severe, n = 16). Aortic valve calcium volume score on CCT, aortic valve area, LV mass index, LV end-diastolic volume index on CMR, presence of mild aortic regurgitation (AR), transaortic mean pressure gradient, and peak velocity on TTE were significantly different among the three groups and were associated with severity of MF on a univariate multinomial logistic regression analysis. Aortic valve calcium grade was different (p = 0.008) among the three groups but not associated with severity of MF (p = 0.375).
  
  
  CONCLUSIONS
  A multi-imaging approach shows that severe AS with MF is significantly associated with more severe calcific AS, higher LV end-diastolic volume, higher LV mass, and higher prevalence of mild AR.
authors.affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Inyoung
authors.initials: I
authors.lastname: Song
authors.affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Ko
authors.affiliation: Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jeong Geun
authors.initials: JG
authors.lastname: Yi
authors.affiliation: Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Hyun Keun
authors.initials: HK
authors.lastname: Chee
authors.affiliation: Department of Thoracic Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Jun Seok
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures; D004452:Echocardiography; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology