Juliana Hiromi Silva Matsumoto Bello et al. Lea M.M.F. Demarchi Rafael Almeida Fonseca Gabriele N. Lima … Lucas José Tachotti Pires Vitor E. E. Rosa Roney Orismar Sampaio Paulo S. Gutierrez Vera D. Aiello Flávio Tarasoutchi Carlos E. Rochitte
Abstract
Background:
Aortic valve disease may lead to the accumulation of myocardial fibrosis (MF). Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) evaluates regional fibrosis but does not detect interstitial fibrosis, which can be estimated by extracellular volume (ECV) using native (pre-contrast) and post-contrast T1 mapping.
Objectives:
To compare MF measured by collagen volume fraction (CVF) in myocardial biopsy with LGE and ECV in patients with severe aortic valve disease.
Methods:
A total of 108 patients undergoing aortic valve replacement with myocardial biopsy and preoperative CMR were included. LGE and ECV were compared with CVF using Pearson or Spearman correlation coefficients, diagnostic performance analysis, and agreement testing. Statistical significance was set at p < 0.05.
Results:
Increased CVF was observed in 96% of patients (21.9 ± 5.5%), LGE in 44% (1.3 ± 3%), and increased ECV in 33.3% (29.0 ± 4.0%). Moderate correlations were found between LGE and CVF and between ECV and CVF (r = 0.44 and r = 0.36, respectively; p = 0.001). LGE and ECV demonstrated sensitivities of 64.8% and 40.7%, specificities of 77.8% and 74.1%, and accuracies of 71% and 57%, respectively, using CVF above the median as the reference for MF. Agreement between CVF and ECV revealed a mean difference of −0.167 and a Cohen’s kappa value of 0.171.
Conclusions:
CMR detects MF in patients with severe aortic valve disease confirmed by biopsy. LGE and ECV show moderate correlation with CVF. Combined analysis of LGE and ECV may provide complementary information; however, additional studies are needed to determine their prognostic impact.
