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Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Sobota, V; Augustin, CM; Plank, G; Vigmond, EJ; Nordmeyer, S; Bayer, JD.
Increased extracellular volume after aortic valve replacement: a footprint of reverse ventricular remodeling that does not affect conduction velocity.
J Cardiovasc Magn Reson. 2025; 101936
Doi: 10.1016/j.jocmr.2025.101936
PubMed
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- Autor*innen der Med Uni Graz:
- Augustin Christoph
- Plank Gernot
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- Abstract:
- BACKGROUND: Extracellular volume (ECV) determined by cardiovascular magnetic resonance (CMR) is considered a marker of diffuse myocardial fibrosis and a predictor of mortality. Using personalized computational models, we investigated the relationship between ECV, conduction velocity (CV), and cell radius in aortic stenosis (AS) patients. METHODS: CMR was performed on 12 AS patients (6 males, 6 females) before and 3 months after surgical aortic valve replacement (AVR). All patients had a QRS≤110 ms, and no scar on late gadolinium enhanced (LGE) CMR. Computational biventricular models were developed from each CMR dataset. Using patient-specific ECV and the relative change in cell radius between the time points as inputs, tissue conductivity was adjusted in each model to match the patient's QRS duration. A physiological pattern of ventricular depolarization was mimicked by simultaneously pacing each model from 5 activation sites. CV was measured during a simulation of apical pacing, using two points positioned at the right ventricular septum of the model. RESULTS: Left ventricular mass decreased after AVR (62 [58-79] vs. 51 [41-60] g/m2, p=0.0005) while ECV increased (24.2 [20.6-24.8] vs. 28.0 [25.1-29.5] %, p=0.0008). No changes in the patient's QRS duration (89.0 [80.5-99.0] vs. 88 [78.5-99.5] ms, p=0.2148) were observed. No changes in the CV obtained from the models (64.3 [61.9-72.8] vs. 66.0 [60.0-74.5] cm/s, p=0.5186) were found between the time points, suggesting there was no substantial increase in diffuse fibrosis. ECV was negatively correlated with cell radius (r=-0.5267, p=0.0082), but not correlated with CV obtained from the models (r=-0.2036, p=0.3399). CONCLUSION: Increased ECV 3 months after AVR in patients with no LGE scar and with normal ventricular conduction appears to be a footprint of reverse ventricular remodeling that does not necessarily translate into changes in myocardial CV.