in Severe Aortic Stenosis Data from the BSCMR Valve Consortium British Society of Cardiovascular Magnetic Resonance BSCMR AS700 Scar Predicts Mortality in Aortic Stenosis LateBreaking Registry Results ID: 1006589
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1. Myocardial Scar Predicts Mortality in Severe Aortic Stenosis: Data from the BSCMR Valve ConsortiumBritish Society of Cardiovascular Magnetic Resonance BSCMR AS700Scar Predicts Mortality in Aortic StenosisLate-Breaking Registry Results 03.01 - Aortic valve disease - 3144Thomas Treibel, Tarique Musa, Vass Vassiliou, Gabriella Captur, Anvesha Singh, Calvin Chin, Margaret Loudon, Marcia Rigolli, Laura Dobson, Silvia Pica, Tamir Malley, James Foley, Petra Bjisterveld, Graham Law, Mark Dweck, Saul Myerson, Gerry McCann, Sanjay Prassad, James Moon, John Greenwood
2. Background – Aortic StenosisMost common cardiovascular disease after atherosclerosis and hypertensionIntervention improves survival 1,2Risk stratification and timing of intervention is primarily based on 1,2severity of the stenosissymptom onsetimpaired LV function1Vahanian A, et al. EHJ 2012; 33(19): 2451-96. 2Nishimura RA et al. JACC 2017 Jul 11;70(2):252-289.
3. Background – Challenges Symptoms can be difficult to elucidateLV systolic dysfunction occurs lateRisk: - Awaiting intervention - Residual, post intervention (irreversible changes)Objective and early markers of cardiac decompensation needed Heart failureArrhythmiaDeath
4. Background – Myocardial Scar Key to transition from hypertrophy to heart failure 1 CMR detects fibrosis using late gadolinium enhancement (LGE) Single-centre studies: Fibrosis associated with LV decompensation and adverse clinical outcomes 2,3,41Weidemann et. al. Circulation 2009; 120(7): 577-84.2Azevedo et. al. JACC 2010; 56(4): 278-87.3Dweck et. al. JACC 2011; 58(12): 1271-9.4Barone-Rochette et. al. JACC 2014; 64(2): 144-54.
5. HypothesisParameters of left ventricular adaptation are incremental predictors of mortality after valve intervention in aortic stenosis HypertrophyDilatationImpairmentScar
6. Study DesignLongitudinal, observational outcome study Patients with severe AS 1 Listed for valve intervention (SAVR or TAVI)2 Prospectively recruited after Heart Team evaluationEchocardiography and CMR as part of work-upPrognostic value of derived imaging parameters Primary endpoint: All-cause mortality Secondary endpoint: Cardiovascular mortalitySix UK surgical centres between January 2003 and May 2015 2Exclusion criteria: pregnancy/breastfeeding, estimated GFR <30mL/min/1·73m2, CMR non-conditional devices. EdinburghLeedsLeicesterOxfordLondon(UCL, Imperial)
7. Multi-centre, multi-modality study in severe aortic stenosis (n=703)High mortality (24% at median 3.6 years)Scar doubles mortality.all-cause (28·7% vs 14·5%; p<0·001) and cardiovascular mortality (16·6% vs 6·4%; p<0·001)Regardless of aetiology (infarct or non) or intervention Sole independent predictors of all-cause mortality: Age (HR 1·07, p<0.001)Scar presence (HR 2·13, p=0·003) Female sex (HR 1·69, p=0.018) 1% increase scar burden10% increased all-cause mortality9% increased cardiovascular mortalityAS700 British Society of Cardiovascular Magnetic Resonance Residual Risk after Intervention in Aortic StenosisMyocardial Scar Predicts Mortality in Severe Aortic Stenosis: Data from the BSCMR Valve ConsortiumThomas Treibel, Tarique Musa, Vass Vassiliou, Gabriella Captur, Anvesha Singh, Calvin Chin, Margaret Loudon, Marcia Rigolli, Laura Dobson, Silvia Pica, Tamir Malley, James Foley, Petra Bjisterveld, Graham Law, Mark Dweck, Saul Myerson, Gerry McCann, Sanjay Prassad, James Moon, John Greenwood
8. Conclusion – in severe Aortic StenosisSignificant mortality at 3.6 years = 24%Myocardial scar is a key outcome predictorPresent in 51% Doubles mortality1% in scar = 10% in mortalityStrongest independent predictor of all-cause and cardiovascular mortality Timing valve intervention to pre-empt scar development or progression now warrants clinical trial investigation.