The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Myocardial fibrosis in patients undergoing transcatheter aortic valve replacement: impact on left ventricular reverse remodeling and long-term outcome

DOI: 10.4244/EIJ-D-19-00641

1. Universitatsklinikum Bonn, Cardiology, Bonn, Germany
2. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
3. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
4. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
5. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
6. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
7. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
8. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
9. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
10. Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Germany, Germany
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Aims: We sought to investigate the relevance of myocardial fibrosis, assessed by mid-wall fibrosis risk (MFR) score, with respect to left ventricular (LV) reverse remodeling following transcatheter aortic valve replacement (TAVR). 

Methods and results: Between January 2010 and March 2015, we enrolled 207 patients in whom baseline MFR, which includes age, sex, high-sensitive cardiac troponin-I, presence of strain pattern on electrocardiograph, and peak-aortic valve velocity, as well one-year follow-up echocardiography were available. LV reverse remodeling was defined as a >10 % reduction in LV end-diastolic volume index (LVEDVi). A higher MFR score (≥52) was associated with increased LVEDVi and with decreased LV ejection fraction as well as higher baseline-NT-pro-BNP levels (p<0.05 for all). One year after the TAVR procedure, a higher MFR score was associated with a decreased probability of LV reverse remodeling (OR 0.33; 95% CI, 0.23-0.87; p=0.03), which was independent of baseline echocardiographic parameters and comorbidities. In contrast, there was no significant difference in five-year mortality between patients with lower and higher MFR score (57.9% vs. 60.5%, p=0.66). 

Conclusions: A higher MFR score is associated with reduced LV reverse remodeling at one-year follow-up, whereas the MFR score does not appear to interfere with long-term mortality after TAVR.

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