Cardiac Magnetic Resonance Imaging and Histology in Aortic Valve Disease: Convergences and Limitations

Myocardial fibrosis is a central element of ventricular remodeling in severe aortic valve disease and is associated with ventricular dysfunction and worse outcomes, even after valve intervention.^– Although the collagen volume fraction obtained by histology represents the gold standard for quantifying interstitial fibrosis, myocardial biopsy is not part of routine clinical practice due to its invasive nature and sample limitations. In this context, cardiac magnetic resonance imaging (CMR) has become established as a non-invasive method for tissue characterization, allowing the identification of regional fibrosis through late enhancement and the estimation of interstitial expansion through T1 mapping and calculation of extracellular volume (ECV).^–

The study published in this issue of the Arquivos Brasileiros de Cardiologia makes a significant contribution by directly comparing CMR parameters with the collagen volume fraction obtained by myocardial biopsy in 108 patients with severe aortic valve disease who underwent surgery. Unlike many previous series composed exclusively of aortic stenosis, this cohort also included patients with aortic insufficiency, broadening the applicability of the findings and incorporating a more comprehensive pathophysiological spectrum of ventricular overload.

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