Article Text

Download PDFPDF

16 Myocardial extracellular volume in patients with aortic stenosis undergoing valve intervention: a multicentre T1 mapping study
  1. Russell J Everett1,
  2. Thomas A Treibel2,
  3. Miho Fukui3,
  4. Heesun Lee4,
  5. Marzia Rigolli5,
  6. Anvesha Singh6,
  7. Petra Bijsterveld7,
  8. Lionel Tastet8,
  9. Tarique Al Musa7,
  10. Laura Dobson7,
  11. Calvin Chin9,
  12. Gabriella Captur2,
  13. Stephanie Funk10,
  14. Jeanette Schulz-Menger10,
  15. Erik B Schelbert3,
  16. Marie-Annick Clavel8,
  17. David E Newby1,
  18. Saul Myerson5,
  19. Phillipe Pibarot8,
  20. João L Cavalcante3,
  21. Seung-Pyo Lee4,
  22. Gerry McCann6,
  23. John P Greenwood7,
  24. James Moon2,
  25. Marc R Dweck1
  1. 1Centre for Cardiovascular Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, UK
  2. 2Barts Health NHS Trust and University College London, London, UK
  3. 3UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
  4. 4Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
  5. 5University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK
  6. 6Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
  7. 7Multidisciplinary Cardiovascular Research Centre and The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  8. 8Quebec Heart and Lung Institute, Department of Medicine, Quebec, Canada
  9. 9National Heart Center, Singapore
  10. 10HELIOS Hospital Berlin-Buch, Berlin, Germany


Background Diffuse myocardial fibrosis is a key decompensation mechanism in advanced aortic stenosis (AS) and can be quantified using CMR T1 mapping techniques.

Purpose To assess T1 mapping measures of fibrosis in patients with severe AS referred for aortic valve replacement, and determine their associations with clinical characteristics, disease severity and clinical outcome.

Methods In this international prospective cohort study, patients with severe AS underwent CMR at 1.5T and 3T (Siemens/Philips) with T1 mapping prior to AVR. Image analysis was performed (CVI42, Circle) by a single core laboratory for three T1 mapping measures (native T1, extracellular volume fraction [ECV%] and indexed extracellular volume [iECV=LVMi*ECV%]).

Results Four-hundred patients (70±10 years, 60% male) from nine international centres (Canada/Germany/Korea/USA/UK) were enrolled (including 144 patients from BSCMR AS700 study). AVR was performed (SAVR: n=342, TAVI: n=58) 19 [4-61] days following CMR, with median of 3.8 [1.7–4.5] years follow-up and 40 deaths recorded.

As expected, native T1 was higher at 3T than 1.5T (1213±57 versus 1050±48 ms, p<0.001); ECV% did not vary by scanner manufacturer, field strength or T1 mapping sequence (all p>0.30); therefore, only ECV-based measures were analysed.

ECV% correlated with increasing age, Society of Thoracic Surgeons Predicted Risk of Mortality score, known coronary artery disease, lower aortic valve peak velocity, increased LV mass, presence of late gadolinium enhancement (LGE) and reduced LVEF (p<0.05 for all). Following adjustment for demographic and clinical variables, ECV% remained associated with both LVEF (p<0.001) and mass index (p=0.043). Similar associations were seen with iECV.

A progressive increase in all-cause mortality was seen across tertiles of ECV% (14.0, 28.5 and 53.7 deaths per 1000 patient-years; log-rank test, p=0.003). ECV% was independently associated with all-cause mortality following adjustment for age, sex, peak velocity, impaired LVEF and presence of LGE (HR per% increase in ECV%: 1.13, 95%, 1.04–1.24, p=0.006). iECV was associated with all-cause mortality following adjustment for age and sex (HR 1.03 95% 1.00–1.06, p=0.04) but not after adjustment for the above clinical variables.

Conclusion In patients with severe AS scheduled for AVR, extracellular volume-based T1 mapping measures are robust, track with LV decompensation, and independently predict late all-cause mortality.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.