The Role of Myocardial Fibrosis in Patients With Aortic Stenosis

Study Overview
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Brief Summary
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Aortic stenosis is the most common adult valvular heart disease in the western world. Heart failure and sudden cardiac death are complications associated with aortic stenosis. In symptomatic individuals, valve replacement is often the only effective treatment. However, there are no good markers to identify patients who may benefit from early surgery before symptoms developed. The purpose of the study is to test the hypothesis that the presence heart muscle scarring on the cardiac magnetic resonance imaging may predict a worse outcome in patients with aortic stenosis, and thus may be helpful in identifying patients for early valve replacement.

Detailed Description
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Congestive heart failure and sudden cardiac death are associated complications of aortic stenosis. Currently, the indications for valvular replacement are based on the valvular severity evaluated by echocardiography and the presence of symptoms. There is some evidence to suggest the presence of myocardial fibrosis is associated with a poor outcome in patients with aortic stenosis. The aim of this prospective study is to investigate the prognostic implications of myocardial fibrosis in patients with aortic stenosis. The presence of myocardial fibrosis will be identified by delayed enhancement with the cardiac magnetic resonance imaging at 3T. We will also be evaluating the application of T1 mapping techniques to detect diffuse myocardial fibrosis.

Official Title
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The Role of Myocardial Fibrosis in Patients With Aortic Stenosis

Conditions
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Aortic Stenosis

Intervention / Treatment
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* Other: Cardiac Magnetic Resonance Imaging
* Other: Echocardiography
* Other: 72 hour Holter Monitor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with aortic stenosis Willing to undergo all investigations Exclusion Criteria: Coexisting mitral valvular heart disease and aortic regurgitation (more than moderate severity) Active medical conditions: ongoing heart failure, infection Significant comorbidities: advanced malignancy with limited life expectancy Unable to give informed consent Contraindication for cardiac magnetic resonance imaging: impaired renal function, pacemaker, claustrophobia

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Controls<br>Patients will undergo cardiac magnetic resonance imaging, echocardiography and 72 hour holter monitoring | Other: Cardiac Magnetic Resonance Imaging<br>* For the evaluation of left ventricular volumes, function and mass. Also for the assessment of myocardial fibrosis based on the presence of delayed enhancement. Novel application of T1 mapping techniques will be evaluated.<br>Other: Echocardiography<br>* Assessment of aortic stenosis severity. Also evaluate diastolic and systolic function.<br>Other: 72 hour Holter Monitor<br>* This will enable us to detect abnormal heart rhythms which may be associated with myocardial fibrosis<br>|
| Aortic Stenosis patients<br>All patients who agreed to study will undergo cardiac magnetic resonance imaging, echocardiography and 72 hour holter monitoring | Other: Cardiac Magnetic Resonance Imaging<br>* For the evaluation of left ventricular volumes, function and mass. Also for the assessment of myocardial fibrosis based on the presence of delayed enhancement. Novel application of T1 mapping techniques will be evaluated.<br>Other: Echocardiography<br>* Assessment of aortic stenosis severity. Also evaluate diastolic and systolic function.<br>Other: 72 hour Holter Monitor<br>* This will enable us to detect abnormal heart rhythms which may be associated with myocardial fibrosis<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cardiovascular events | Cardiovascular events defined as cardiovascular deaths, development of heart failure symptoms, and the need for aortic valve replacement. | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Aortic Stenosis, Cardiac magnetic resonance imaging, Late Gadolinium enhancement, T1 mapping techniques, Replacement fibrosis, Diffuse interstitial fibrosis