Myocardial Scar and Mortality in Chronic Aortic Regurgitation
Background Chronic aortic regurgitation (AR) can be associated with myocardial scarring. It is unknown if scarring in AR is linked to poor outcomes and whether aortic valve replacement impacts this association. We investigated the relationship of myocardial scarring to mortality in chronic AR using...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-12-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018731 |
| _version_ | 1818327990662070272 |
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| author | Maan Malahfji Alpana Senapati Bhupendar Tayal Duc T. Nguyen Edward A. Graviss Sherif F. Nagueh Michael J. Reardon Miguel Quinones William A. Zoghbi Dipan J. Shah |
| author_facet | Maan Malahfji Alpana Senapati Bhupendar Tayal Duc T. Nguyen Edward A. Graviss Sherif F. Nagueh Michael J. Reardon Miguel Quinones William A. Zoghbi Dipan J. Shah |
| author_sort | Maan Malahfji |
| collection | DOAJ |
| description | Background Chronic aortic regurgitation (AR) can be associated with myocardial scarring. It is unknown if scarring in AR is linked to poor outcomes and whether aortic valve replacement impacts this association. We investigated the relationship of myocardial scarring to mortality in chronic AR using cardiac magnetic resonance. Methods and Results We enrolled patients with moderate or greater AR between 2009 and 2019 and performed a blinded assessment of left ventricle remodeling, AR severity, and presence and extent of myocardial scarring by late gadolinium enhancement. The primary outcome was all‐cause mortality. We followed 392 patients (median age 62 [interquartile range, 51–71] years), and 78.1% were men, and 25.8% had bicuspid valves. Median aortic valve regurgitant volume was 39 mL (interquartile range, 30–60). Myocardial scar was present in 131 (33.4%) patients. Aortic valve replacement was performed in 165 (49.1%) patients. During follow‐up, up to 10.8 years (median 32.3 months [interquartile range, 9.8–69.5]), 51 patients (13%) died. Presence of myocardial scar (hazard ratio [HR], 3.62; 95% CI, 2.06–6.36; P<0.001), infarction scar (HR, 4.94; 95% CI, 2.58–9.48; P<0.001), and noninfarction scar (HR, 2.75; 95% CI, 1.39–5.44; P<0.004) were associated with mortality. In multivariable analysis, the presence of scar remained independently associated with death (HR, 2.53; 95% CI, 1.15–5.57; P=0.02). Among patients with myocardial scar, aortic valve replacement was independently associated with a lower risk of mortality (HR, 0.34; 95% CI, 0.12–0.97; P=0.03), even after adjustment for confounders. Conclusions In aortic regurgitation, myocardial scar is independently associated with a 2.5‐fold increase risk in mortality. Aortic valve replacement was associated with a reduction in risk of mortality in patients with scarring. |
| first_indexed | 2024-12-13T12:25:03Z |
| format | Article |
| id | doaj.art-4adb74da633b488db25686846282fa5e |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T12:25:03Z |
| publishDate | 2020-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-4adb74da633b488db25686846282fa5e2022-12-21T23:46:23ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-12-0192310.1161/JAHA.120.018731Myocardial Scar and Mortality in Chronic Aortic RegurgitationMaan Malahfji0Alpana Senapati1Bhupendar Tayal2Duc T. Nguyen3Edward A. Graviss4Sherif F. Nagueh5Michael J. Reardon6Miguel Quinones7William A. Zoghbi8Dipan J. Shah9Houston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXDepartment of Pathology and Genomic Medicine Houston Methodist Hospital Research Institute Houston TXDepartment of Pathology and Genomic Medicine Houston Methodist Hospital Research Institute Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXHouston Methodist DeBakey Heart & Vascular Center Houston TXBackground Chronic aortic regurgitation (AR) can be associated with myocardial scarring. It is unknown if scarring in AR is linked to poor outcomes and whether aortic valve replacement impacts this association. We investigated the relationship of myocardial scarring to mortality in chronic AR using cardiac magnetic resonance. Methods and Results We enrolled patients with moderate or greater AR between 2009 and 2019 and performed a blinded assessment of left ventricle remodeling, AR severity, and presence and extent of myocardial scarring by late gadolinium enhancement. The primary outcome was all‐cause mortality. We followed 392 patients (median age 62 [interquartile range, 51–71] years), and 78.1% were men, and 25.8% had bicuspid valves. Median aortic valve regurgitant volume was 39 mL (interquartile range, 30–60). Myocardial scar was present in 131 (33.4%) patients. Aortic valve replacement was performed in 165 (49.1%) patients. During follow‐up, up to 10.8 years (median 32.3 months [interquartile range, 9.8–69.5]), 51 patients (13%) died. Presence of myocardial scar (hazard ratio [HR], 3.62; 95% CI, 2.06–6.36; P<0.001), infarction scar (HR, 4.94; 95% CI, 2.58–9.48; P<0.001), and noninfarction scar (HR, 2.75; 95% CI, 1.39–5.44; P<0.004) were associated with mortality. In multivariable analysis, the presence of scar remained independently associated with death (HR, 2.53; 95% CI, 1.15–5.57; P=0.02). Among patients with myocardial scar, aortic valve replacement was independently associated with a lower risk of mortality (HR, 0.34; 95% CI, 0.12–0.97; P=0.03), even after adjustment for confounders. Conclusions In aortic regurgitation, myocardial scar is independently associated with a 2.5‐fold increase risk in mortality. Aortic valve replacement was associated with a reduction in risk of mortality in patients with scarring.https://www.ahajournals.org/doi/10.1161/JAHA.120.018731aortic regurgitationaortic valve replacementcardiac magnetic resonancemyocardial scar |
| spellingShingle | Maan Malahfji Alpana Senapati Bhupendar Tayal Duc T. Nguyen Edward A. Graviss Sherif F. Nagueh Michael J. Reardon Miguel Quinones William A. Zoghbi Dipan J. Shah Myocardial Scar and Mortality in Chronic Aortic Regurgitation Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic regurgitation aortic valve replacement cardiac magnetic resonance myocardial scar |
| title | Myocardial Scar and Mortality in Chronic Aortic Regurgitation |
| title_full | Myocardial Scar and Mortality in Chronic Aortic Regurgitation |
| title_fullStr | Myocardial Scar and Mortality in Chronic Aortic Regurgitation |
| title_full_unstemmed | Myocardial Scar and Mortality in Chronic Aortic Regurgitation |
| title_short | Myocardial Scar and Mortality in Chronic Aortic Regurgitation |
| title_sort | myocardial scar and mortality in chronic aortic regurgitation |
| topic | aortic regurgitation aortic valve replacement cardiac magnetic resonance myocardial scar |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018731 |
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