Myocardial fibrosis in severe asymptomatic versus symptomatic aortic stenosis: A cardiac magnetic resonance cross-sectional study

TL;DR

This study found that severe asymptomatic and symptomatic aortic stenosis patients have similar levels of heart tissue damage, suggesting damage occurs before symptoms appear.

Contribution

The study is the first to compare myocardial fibrosis in asymptomatic and symptomatic aortic stenosis using cardiac MRI markers.

Findings

No significant differences in myocardial fibrosis markers between asymptomatic and symptomatic aortic stenosis patients.

Myocardial damage appears to occur before symptoms develop in severe aortic stenosis.

Native T1, ECV%, and LGE showed similar fibrosis severity in both groups.

Abstract

Purpose The degree of myocardial fibrosis may guide the timing of aortic valve replacement in patients with severe asymptomatic aortic valve stenosis (AS). We aimed to examine the prevalence and degree of myocardial fibrosis in severe asymptomatic AS compared with severe symptomatic AS. Methods We prospectively included 42 patients with severe asymptomatic AS and 80 patients with severe symptomatic AS, all with a left ventricular ejection fraction ≥ 50% and no ischemic heart disease. All patients underwent a standard cardiac magnetic resonance examination, including native T1 mapping. Gadolinium contrast was administered to evaluate extracellular volume fraction (ECV%) and late gadolinium enhancement (LGE). Results There were no differences in myocardial fibrosis markers when comparing symptomatic with asymptomatic patients and adjusting for sex, age, and aortic peak velocity, including native T1 (mean difference [MD] -1 ms; 95% confidence interval [CI] -11 to 10; p = 0.90), ECV% (MD 0.2%; 95% CI -1 to 1; p = 0.65), LGE prevalence (odd ratio [OR] 1.2; 95% CI 0.4 to 3.3; p = 0.72), and a combined binary high- or low-grade fibrosis parameter (OR 1.1; 95% CI 0.3 to 4.0; p = 0.94). Conclusion Patients with severe asymptomatic AS exhibited similar severity of myocardial fibrosis markers as those with severe symptomatic AS, suggesting that substantial myocardial damage precedes symptom development.

AS, aortic valve stenosis; ECV, extracellular volume; LGE, late gadolinium enhancement Created with BioRender.

The online version contains supplementary material available at 10.1007/s10554-025-03519-2.

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