Portal de Periódicos da CAPES

Imaging and Impact of Myocardial Fibrosis in Aortic Stenosis

2019; Elsevier BV; Volume: 12; Issue: 2 Linguagem: Inglês

10.1016/j.jcmg.2018.11.026

1936-878X

Rong Bing, João L. Cavalcante, Russell J. Everett, Marie‐Annick Clavel, David E. Newby, Marc R. Dweck,

Cardiac Imaging and Diagnostics

Aortic stenosis is characterized both by progressive valve narrowing and the left ventricular remodeling response that ensues. The only effective treatment is aortic valve replacement, which is usually recommended in patients with severe stenosis and evidence of left ventricular decompensation. At present, left ventricular decompensation is most frequently identified by the development of typical symptoms or a marked reduction in left ventricular ejection fraction <50%. However, there is growing interest in using the assessment of myocardial fibrosis as an earlier and more objective marker of left ventricular decompensation, particularly in asymptomatic patients, where guidelines currently rely on nonrandomized data and expert consensus. Myocardial fibrosis has major functional consequences, is the key pathological process driving left ventricular decompensation, and can be divided into 2 categories. Replacement fibrosis is irreversible and identified using late gadolinium enhancement on cardiac magnetic resonance, while diffuse fibrosis occurs earlier, is potentially reversible, and can be quantified with cardiac magnetic resonance T