Purpose
The aim of our systematic review is to provide a more global perspective of aortic stenosis disease, under the era of CMR. It is a great challenge even the attempt to distinguish between normal and pathological ranges, all throughout diverse expressions of the disease in different stages, and the combined use of distinctive CMR techniques as Late Gadolinium Enhancement, Mapping technique, LV function and Strain, can provide a great advantage in daily practice.
Methods and Materials
We performed a systematic search using MEDLINE and Google Scholar. Keywords included in our research were CMR, Aortic Stenosis (AS) and Myocardial Fibrosis. The chosen articles were included in our study, if they supported a solid approach in left ventricular changes in patients with aortic valve stenosis.
The most important findings of the studies consisted on:
Myocardial fibrosis
is stated as a substantial expansion collagen fiber in myocardial tissue (4). There have been described different subtypes of myocardial fibrosis:
-Reactive interstitial fibrosis
-Infiltrative interstitial fibrosis...
Results
We retrieved and analyzed47 different studies (fig.6) and 12 different review papers (fig.1). Since 2006 over 3860 patients with of aortic valve stenosis have been enrolled and evaluated, as well as 500 controls. Nowadays huge trials as EVoLVeD (Early Valve Replacement Guided by Biomarkers of Left Ventricular Decompensation in Asymptomatic Patients with Severe Aortic Stenosis (NTC003094143) are investigating new biomarkers to lead the forgoing strategic evaluation over targeting most beneficiary therapeutic patients’ approach.
Aortic valve stenosis is a disease with a complex phenotype, and its...
Conclusion
As new insights in an old disease, provided by the use of cardiac MRI (which is the reference standard for the assessment of myocardial fibrosis) highlighted potential re-staging of affected patients, we believe that a more proper therapeutic approach is on the way.
References
1.Nishimura RA, Otto CM, Bonow RO, Carabello BA et al.American College of Cardiology/American Heart Association Task Force on Practice Guidelines.2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185. doi: 10.1016/j.jacc.2014.02.536.2
2.Falk V, Baumgartner H, Bax JJ, De Bonis M et al.ESC Scientific Document Group.2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur J Cardiothorac Surg. 2017 Oct 1;52(4):616-664. doi: 10.1093/ejcts/ezx324....